Clinical application of slope-reducing tibial osteotomy and anterior cruciate ligament revision in patients with abnormally increased posterior tibial slope_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

Nijiati·Abulimiti , LI Gang , SUN Xuebin , ZHANG Keyuan ,  LIU Yang

Department of Sports Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi Xijiang, 830054, P. R. China;

Corresponding author：

LIU Yang, Email: 8861450@qq.com

Keywords：

Posterior tibial slope; anterior tibial translation; slope-reducing tibial osteotomy; anterior cruciate ligament; revision

DOI：

10.7507/1002-1892.202108088

Video：

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Objective To investigate the effectiveness of slope-reducing tibial osteotomy and anterior cruciate ligament (ACL) revision in the treatment of patients with primary ACL reconstruction failure and abnormally increased posterior tibial slope (PTS). Methods The clinical data of 9 patients with primary ACL reconstruction failure and abnormally increased PTS (≥17°) who met the selection criteria between January 2018 and January 2020 were retrospectively analyzed. There were 8 males and 1 female; the age ranged from 21 to 42 years, with a median age of 30 years. Lachman test was positive in 9 patients. Pivot-shift test was negative in 6 cases, degree Ⅰ positive in 2 cases, and degree Ⅱ positive in 1 case. The PTS was (17.78±1.09)° and the anterior tibial translation (ATT) was (11.58±1.47) mm. The International Knee Documentation Committee (IKDC) score was 51.0±3.8, Lysholm score was 49.7±4.6, and Tegner score was 3.7±0.7. The time from primary reconstruction to revision was 12-33 months, with an average of 19.6 months. Slope-reducing tibial osteotomy and ACL revision were performed. The improvement of knee function was evaluated by IKDC score, Lysholm score, and Tegner score; Lachman test and Pivot-shift test were used to evaluate the stability of knee joint. PTS and ATT were measured to observe the morphological changes of knee joint. Results All the incisions healed by first intention, and there was no complication such as incision infection, fat liquefaction, necrosis, deep vein thrombosis of lower extremities, and neurovascular injury. All 9 patients were followed up 12-36 months, with an average of 25.8 months. At last follow-up, Lachman test and pivot-shift test were negative. IKDC score was 85.0±4.0, Lysholm score was 87.7±2.8, Tegner score was 6.8±0.7, PTS reduced to (9.89±0.60)°, and ATT shortened to (0.91±0.29) mm, which were significantly improved when compared with those before operation (P<0.05). Conclusion Slope-reducing tibial osteotomy and ACL revision in the treatment of patients with primary ACL reconstruction failure and abnormally increased PTS has a satisfactory short-term effectiveness. It can improve the stability of knee joint and maintain the normal shape of knee joint.

Citation： Nijiati·Abulimiti, LI Gang, SUN Xuebin, ZHANG Keyuan, LIU Yang. Clinical application of slope-reducing tibial osteotomy and anterior cruciate ligament revision in patients with abnormally increased posterior tibial slope. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(1): 52-57. doi: 10.7507/1002-1892.202108088 Copy

1.	Lind M, Lund B, Faunø P, et al. Medium to long-term follow-up after ACL revision. Knee Surg Sports Traumatol Arthrosc, 2012, 20(1): 166-172.
2.	Kraeutler MJ, Welton KL, McCarty EC, et al. Revision anterior cruciate ligament reconstruction. J Bone Joint Surg (Am), 2017, 99(19): 1689-1696.
3.	Vap AR, Persson A, Fenstad AM, et al. Re-revision anterior cruciate ligament reconstruction: An evaluation from the norwegian knee ligament registry. Arthroscopy, 2019, 35(6): 1695-1701.
4.	Gifstad T, Drogset JO, Viset A, et al. Inferior results after revision ACL reconstructions: a comparison with primary ACL reconstructions. Knee Surg Sports Traumatol Arthrosc, 2013, 21(9): 2011-2018.
5.	Yoon KH, Kim JH, Kwon YB, et al. Re-revision anterior cruciate ligament reconstruction showed more laxity than revision anterior cruciate ligament reconstruction at a minimum 2-year follow-up. Knee Surg Sports Traumatol Arthrosc, 2020, 28(6): 1909-1918.
6.	Wright RW, Johnson L, Brophy RH, et al. Revision anterior cruciate ligament reconstruction outcomes at a minimum of 5-year follow-up: A systematic review. J Knee Surg, 2019, 32(3): 218-221.
7.	倪乾坤, 张辉, 宋关阳, 等. 非接触性前十字韧带损伤初次重建术后失效的危险因素. 中华骨科杂志, 2020, 40(7): 389-396.
8.	Marouane H, Shirazi-Adl A, Hashemi J. Quantification of the role of tibial posterior slope in knee joint mechanics and ACL force in simulated gait. J Biomech, 2015, 48(10): 1899-1905.
9.	Dare DM, Fabricant PD, McCarthy MM, et al. Increased lateral tibial slope is a risk factor for pediatric anterior cruciate ligament injury: An MRI-based case-control study of 152 patients. Am J Sports Med, 2015, 43(7): 1632-1639.
10.	Beynnon BD, Hall JS, Sturnick DR, et al. Increased slope of the lateral tibial plateau subchondral bone is associated with greater risk of noncontact ACL injury in females but not in males: a prospective cohort study with a nested, matched case-control analysis. Am J Sports Med, 2014, 42(5): 1039-1048.
11.	Klemt C, Bounajem G, Tirumala V, et al. Posterior tibial slope increases anterior cruciate ligament stress in Bi-cruciate retaining total knee arthroplasty: In vivo kinematic analysis. J Knee Surg, 2020. doi: 10.1055/s-0040-1718602.
12.	李岳, 洪雷, 冯华, 等. 胫骨平台后倾角对前十字韧带重建术后膝关节前向稳定性的影响. 中华骨科杂志, 2013, 33(9): 917-922.
13.	Li Y, Hong L, Feng H, et al. Posterior tibial slope influences static anterior tibial translation in anterior cruciate ligament reconstruction: a minimum 2-year follow-up study. Am J Sports Med, 2014, 42(4): 927-933.
14.	Gwinner C, Weiler A, Roider M, et al. Tibial slope strongly influences knee stability after posterior cruciate ligament reconstruction: A prospective 5- to 15-year follow-up. Am J Sports Med, 2017, 45(2): 355-361.
15.	宋关阳, 张辉, 冯华. 前十字韧带损伤后胫骨过度前移对重建术后膝关节稳定性的影响. 中华骨科杂志, 2019, 39(7): 392-397.
16.	Webb JM, Salmon LJ, Leclerc E, et al. Posterior tibial slope and further anterior cruciate ligament injuries in the anterior cruciate ligament-reconstructed patient. Am J Sports Med, 2013, 41(12): 2800-2804.
17.	Ni QK, Song GY, Zhang ZJ, et al. Steep posterior tibial slope and excessive anterior tibial translation are predictive risk factors of primary anterior cruciate ligament reconstruction failure: A case-control study with prospectively collected data. Am J Sports Med, 2020, 48(12): 2954-2961.
18.	Sonnery-Cottet B, Mogos S, Thaunat M, et al. Proximal tibial anterior closing wedge osteotomy in repeat revision of anterior cruciate ligament reconstruction. Am J Sports Med, 2014, 42(8): 1873-1880.
19.	Dejour D, Saffarini M, Demey G, et al. Tibial slope correction combined with second revision ACL produces good knee stability and prevents graft rupture. Knee Surg Sports Traumatol Arthrosc, 2015, 23(10): 2846-2852.
20.	Song GY, Ni QK, Zheng T, et al. Slope-reducing tibial osteotomy combined with primary anterior cruciate ligament reconstruction produces improved knee stability in patients with steep posterior tibial slope, excessive anterior tibial subluxation in extension, and chronic meniscal posterior horn tears. Am J Sports Med, 2020, 48(14): 3486-3494.
21.	Su AW, Bogunovic L, Smith MV, et al. Medial tibial slope determined by plain radiography is not associated with primary or recurrent anterior cruciate ligament tears. J Knee Surg, 2020, 33(1): 22-28.
22.	Utzschneider S, Goettinger M, Weber P, et al. Development and validation of a new method for the radiologic measurement of the tibial slope. Knee Surg Sports Traumatol Arthrosc, 2011, 19(10): 1643-1648.
23.	Hudek R, Schmutz S, Regenfelder F, et al. Novel measurement technique of the tibial slope on conventional MRI. Clin Orthop Relat Res, 2009, 467(8): 2066-2072.
24.	Naendrup JH, Drouven SF, Shaikh HS, et al. High variability of tibial slope measurement methods in daily clinical practice: Comparisons between measurements on lateral radiograph, magnetic resonance imaging, and computed tomography. Knee, 2020, 27(3): 923-929.
25.	Ni QK, Song GY, Zhang ZJ, et al. Posterior tibial slope measurements based on the full-length tibial anatomic axis are significantly increased compared to those based on the half-length tibial anatomic axis. Knee Surg Sports Traumatol Arthrosc, 2021. doi: 10.1007/s00167-021-06605-9.

1. Lind M, Lund B, Faunø P, et al. Medium to long-term follow-up after ACL revision. Knee Surg Sports Traumatol Arthrosc, 2012, 20(1): 166-172.
2. Kraeutler MJ, Welton KL, McCarty EC, et al. Revision anterior cruciate ligament reconstruction. J Bone Joint Surg (Am), 2017, 99(19): 1689-1696.
3. Vap AR, Persson A, Fenstad AM, et al. Re-revision anterior cruciate ligament reconstruction: An evaluation from the norwegian knee ligament registry. Arthroscopy, 2019, 35(6): 1695-1701.
4. Gifstad T, Drogset JO, Viset A, et al. Inferior results after revision ACL reconstructions: a comparison with primary ACL reconstructions. Knee Surg Sports Traumatol Arthrosc, 2013, 21(9): 2011-2018.
5. Yoon KH, Kim JH, Kwon YB, et al. Re-revision anterior cruciate ligament reconstruction showed more laxity than revision anterior cruciate ligament reconstruction at a minimum 2-year follow-up. Knee Surg Sports Traumatol Arthrosc, 2020, 28(6): 1909-1918.
6. Wright RW, Johnson L, Brophy RH, et al. Revision anterior cruciate ligament reconstruction outcomes at a minimum of 5-year follow-up: A systematic review. J Knee Surg, 2019, 32(3): 218-221.
7. 倪乾坤, 张辉, 宋关阳, 等. 非接触性前十字韧带损伤初次重建术后失效的危险因素. 中华骨科杂志, 2020, 40(7): 389-396.
8. Marouane H, Shirazi-Adl A, Hashemi J. Quantification of the role of tibial posterior slope in knee joint mechanics and ACL force in simulated gait. J Biomech, 2015, 48(10): 1899-1905.
9. Dare DM, Fabricant PD, McCarthy MM, et al. Increased lateral tibial slope is a risk factor for pediatric anterior cruciate ligament injury: An MRI-based case-control study of 152 patients. Am J Sports Med, 2015, 43(7): 1632-1639.
10. Beynnon BD, Hall JS, Sturnick DR, et al. Increased slope of the lateral tibial plateau subchondral bone is associated with greater risk of noncontact ACL injury in females but not in males: a prospective cohort study with a nested, matched case-control analysis. Am J Sports Med, 2014, 42(5): 1039-1048.
11. Klemt C, Bounajem G, Tirumala V, et al. Posterior tibial slope increases anterior cruciate ligament stress in Bi-cruciate retaining total knee arthroplasty: In vivo kinematic analysis. J Knee Surg, 2020. doi: 10.1055/s-0040-1718602.
12. 李岳, 洪雷, 冯华, 等. 胫骨平台后倾角对前十字韧带重建术后膝关节前向稳定性的影响. 中华骨科杂志, 2013, 33(9): 917-922.
13. Li Y, Hong L, Feng H, et al. Posterior tibial slope influences static anterior tibial translation in anterior cruciate ligament reconstruction: a minimum 2-year follow-up study. Am J Sports Med, 2014, 42(4): 927-933.
14. Gwinner C, Weiler A, Roider M, et al. Tibial slope strongly influences knee stability after posterior cruciate ligament reconstruction: A prospective 5- to 15-year follow-up. Am J Sports Med, 2017, 45(2): 355-361.
15. 宋关阳, 张辉, 冯华. 前十字韧带损伤后胫骨过度前移对重建术后膝关节稳定性的影响. 中华骨科杂志, 2019, 39(7): 392-397.
16. Webb JM, Salmon LJ, Leclerc E, et al. Posterior tibial slope and further anterior cruciate ligament injuries in the anterior cruciate ligament-reconstructed patient. Am J Sports Med, 2013, 41(12): 2800-2804.
17. Ni QK, Song GY, Zhang ZJ, et al. Steep posterior tibial slope and excessive anterior tibial translation are predictive risk factors of primary anterior cruciate ligament reconstruction failure: A case-control study with prospectively collected data. Am J Sports Med, 2020, 48(12): 2954-2961.
18. Sonnery-Cottet B, Mogos S, Thaunat M, et al. Proximal tibial anterior closing wedge osteotomy in repeat revision of anterior cruciate ligament reconstruction. Am J Sports Med, 2014, 42(8): 1873-1880.
19. Dejour D, Saffarini M, Demey G, et al. Tibial slope correction combined with second revision ACL produces good knee stability and prevents graft rupture. Knee Surg Sports Traumatol Arthrosc, 2015, 23(10): 2846-2852.
20. Song GY, Ni QK, Zheng T, et al. Slope-reducing tibial osteotomy combined with primary anterior cruciate ligament reconstruction produces improved knee stability in patients with steep posterior tibial slope, excessive anterior tibial subluxation in extension, and chronic meniscal posterior horn tears. Am J Sports Med, 2020, 48(14): 3486-3494.
21. Su AW, Bogunovic L, Smith MV, et al. Medial tibial slope determined by plain radiography is not associated with primary or recurrent anterior cruciate ligament tears. J Knee Surg, 2020, 33(1): 22-28.
22. Utzschneider S, Goettinger M, Weber P, et al. Development and validation of a new method for the radiologic measurement of the tibial slope. Knee Surg Sports Traumatol Arthrosc, 2011, 19(10): 1643-1648.
23. Hudek R, Schmutz S, Regenfelder F, et al. Novel measurement technique of the tibial slope on conventional MRI. Clin Orthop Relat Res, 2009, 467(8): 2066-2072.
24. Naendrup JH, Drouven SF, Shaikh HS, et al. High variability of tibial slope measurement methods in daily clinical practice: Comparisons between measurements on lateral radiograph, magnetic resonance imaging, and computed tomography. Knee, 2020, 27(3): 923-929.
25. Ni QK, Song GY, Zhang ZJ, et al. Posterior tibial slope measurements based on the full-length tibial anatomic axis are significantly increased compared to those based on the half-length tibial anatomic axis. Knee Surg Sports Traumatol Arthrosc, 2021. doi: 10.1007/s00167-021-06605-9.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical application of slope-reducing tibial osteotomy and anterior cruciate ligament revision in patients with abnormally increased posterior tibial slope

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