Open AccessSlope-Reducing High Tibial Osteotomy and Over-The-Top Anterior Cruciate Ligament Reconstruction With Achilles Tendon Allograft in Multiple Failed Anterior Cruciate Ligament Reconstruction
Author(s) -
Bálint Zsidai,
Emre Anıl Özbek,
Ian D. Engler,
Janina Kaarre,
Ehab M. Nazzal,
Andrew J. Curley,
Volker Musahl
Publication year - 2022
Publication title -
arthroscopy techniques
Language(s) - English
Resource type - Journals
ISSN - 2212-6287
DOI - 10.1016/j.eats.2022.07.019
Subject(s) - medicine , anterior cruciate ligament , surgery , achilles tendon , osteotomy , tibia , high tibial osteotomy , femur , anterior cruciate ligament reconstruction , posterior cruciate ligament , quadriceps tendon , tendon , osteoarthritis , alternative medicine , pathology
Graft failure is a challenging complication following anterior cruciate ligament reconstruction (ACL-R). Among the multiple anatomic and nonanatomic risk factors contributing to ACL-R failure, there is accumulating evidence that a posterior tibial slope of 12° or greater may predispose patients to graft failure of primary and revision ACL-R. In addition, previously malpositioned or widened tunnels, as well as limited autograft options, pose challenges in the setting of revision ACL-R. This Technical Note describes a technique to correct an increased posterior tibial slope using slope-reducing high tibial osteotomy, and single stage revision ACL-R with Achilles tendon allograft using the over-the-top route, in a single-stage procedure. The surgical technique involves an anterior approach to the proximal tibia, followed by tibial tubercle osteotomy and anterior closing-wedge osteotomy. The posterior cortical osteotomy hinge is left intact below the insertion of the posterior cruciate ligament. Over-the-top revision ACL-R is then performed using an Achilles tendon allograft passed around the posterior aspect of the lateral femoral condyle and fixed onto the lateral femur.