title: Tibial slope correction combined with second revision ACL produces good knee stability and prevents graft rupture.
abstract: OBJECTIVE
  Revision ACL reconstruction requires careful analysis of failure causes particularly in cases of two previous graft ruptures. Intrinsic factors as excessive tibial slope or narrow femoral notch increase failure risks but are rarely addressed in revision surgery. The authors report outcomes, at minimum follow-up of 2 years, for second revision ACL reconstructions combined with tibial deflexion osteotomy for correction of excessive slope (>12°).
  
  
  METHODS
  Nine patients that underwent second revision ACL reconstruction combined with tibial deflexion osteotomy were retrospectively studied. The mean age was 30.3 ± 4.4 years (median 28; range 26-37), and mean follow-up was 4.0 ± 2.0 years (median 3.6; range 2.0-7.6). Autografts were harvested from the quadriceps tendon (n = 8) or hamstrings (n = 1), and tibial osteotomy was done by anterior closing wedge, without detachment of the patellar tendon, to obtain a slope of 3° to 5°.
  
  
  RESULTS
  All patients had fused osteotomies, stable knees, and there were no intraoperative or postoperative complications. The mean posterior tibial slope decreased from 13.2° ± 2.6° (median 13°; range 12°-18°) preoperatively to 4.4° ± 2.3° (median 4°; range 2°-8°) postoperatively. The mean Lysholm score was 73.8 ± 5.8 (median 74; range 65-82), and the IKDC-SKF was 71.6 ± 6.1 (median 72.8; range 62.2-78.5).
  
  
  CONCLUSIONS
  The satisfactory results of second revision ACL reconstruction combined with tibial deflexion osteotomy at minimum follow-up of 2 years suggest that tibia slope correction protects reconstructed ACL from fatigue failure in this study. The authors stress the importance of careful analysis failure causes prior to revision ACL reconstruction, and recommend correction of tibial slope if it exceeds 12°, to reduce the risks of graft retear.
  
  
  METHODS
  III.
authors: Lyon-Ortho-Clinic, Clinique de la Sauvegarde, 8 Avenue Ben Gourion, 69009, Lyon, France.
authors: David
authors: D
authors: Dejour
authors: Accelerate Innovation Management SA, 1 Rue de la Navigation, 1201, Geneva, Switzerland. saffarini@mac.com.
authors: Mo
authors: M
authors: Saffarini
authors: Lyon-Ortho-Clinic, Clinique de la Sauvegarde, 8 Avenue Ben Gourion, 69009, Lyon, France.
authors: Guillaume
authors: G
authors: Demey
authors: Lyon-Ortho-Clinic, Clinique de la Sauvegarde, 8 Avenue Ben Gourion, 69009, Lyon, France.
authors: Laurent
authors: L
authors: Baverel
mesh_terms: D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D064592:Autografts; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery*; D065466:Lysholm Knee Score; D008297:Male; D010027:Osteotomy; D012086:Reoperation; D012189:Retrospective Studies; D013710:Tendons / Q000637:transplantation; D013977:Tibia / Q000601:surgery*
keywords: ACL failure; ACL revision; Anterior cruciate ligament; Posterior tibial slope; Tibial closed wedge osteotomy; Tibial deflexion osteotomy