Anterior Closing Wedge Tibial Osteotomy for Failed Anterior Cruciate Ligament Reconstruction

Abstract

The success rate for achieving knee stability in primary anterior cruciate ligament (ACL) reconstruction is high; however, the results of revision reconstruction are less satisfactory. Sagittal plane malalignment is an uncommon predisposing factor for failure because excessive posterior tibial slope increases stress on the ACL graft. In carefully selected patients, tibial slope correction is an essential adjunctive procedure to achieve a stable knee. We present a case report outlining the surgical technique for correction of sagittal plane imbalance by a slope-decreasing anterior closing wedge tibial osteotomy combined with a second-stage revision ACL reconstruction. At 2 years following surgery, our patient had a stable knee and returned to low-impact athletic activity without symptoms. Further investigation is needed to refine the indications for this procedure in the setting of failed ACL reconstruction.

Keywords

deflexion - sagittal plane ACL - ACL revision - anterior closing wedge osteotomy - increased slope

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