Poster 214: Posterior Tibial Slope Reducing Osteotomy in Complex Revision Anterior Cruciate Ligament Reconstruction

Objectives: The purpose of this study was to report indications, early radiologic and clinical outcomes, and postoperative complications after closing wedge slope reducing proximal tibial osteotomy, performed in a complex group of patients with failed ACLR in two academic referrals centers in North America. Methods: A retrospective review of patient medical records was performed at two academic referral centers in North America between October and December 2020. Demographic, radiological, and surgical data were collected on a consecutive series of patients who underwent a closing wedge proximal tibial osteotomy to reduce PTS associated with ACLR failure. Approval for this study was obtained by the institutional review boards of the University of Pittsburgh (No.: STUDY20050226) and the University of Western Ontario (No.: 101533). Written informed consent was obtained from all included patients. Patients were identified from a previous database which included a retrospective two-center sample that underwent R-ACLR between 2010 and 2020 performed by two knee surgeons at the University of Pittsburgh and the University of Western Ontario. The final sample included patients who underwent slope reduction with or without associated coronal alignment correction associated with R-ACLR (n=17). Concomitant procedures such as meniscectomy, meniscal repair, lateral extra-articular tenodesis (LET), meniscal allograft transplantation (MAT), re-operations, and complications were described. Data collection was performed by three orthopedic fellows. R-ACLR was performed in a one-stage or two-stage procedure based on the previous tunnel positions, tunnel widening, and surgeon preferences. In the case of two-stage revision, tibial slope reduction osteotomy was performed as the first stage associated with bone grafting of the tibial and/or femoral tunnel. The tibial slope was corrected using a supra-tubercle anterior closing wedge (ACW) proximal tibial osteotomy (PTO) in 16 patients (Neyret et al 2000) and with a complete tibial tubercle osteotomy (TTO) in one case (Bertrand et al 2014) (Figure 1). Osteotomies were stabilized using Richards regular fixation staples® (Smith & Nephew) or the TOMOFIX® osteotomy system (DePuy Synthes) was used. Techniques were based on the surgeon’s preference. Concomitant LET was performed in patients with a grade III positive pivot shift test during examination under anesthesia. PTS and ATT were calculated using a load-bearing lateral x-ray pre-a