Luke V Tollefson, Matthew T Rasmussen, Grace Guerin, Christopher M LaPrade, Robert F LaPrade
{"title":"Slope reducing proximal tibial osteotomy improves outcomes in ACL reconstruction patients with elevated posterior tibial slope, especially revisions and PTS ≥ 12°.","authors":"Luke V Tollefson, Matthew T Rasmussen, Grace Guerin, Christopher M LaPrade, Robert F LaPrade","doi":"10.1016/j.arthro.2024.10.048","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this systematic review was to explore the indications, outcomes, and complications related to slope reducing osteotomies in the setting of anterior cruciate ligament (ACL) tears or graft failure. A secondary aim was to create an algorithm based on the current literature and authors' opinions.</p><p><strong>Methods: </strong>This study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Studies were included if they reported on outcomes related to slope reducing osteotomies both for primary ACL tears and revision ACL graft tears. The studies were analyzed to determine the radiographic outcomes, patient reported outcomes (PROs), physical exam findings, and complications. Statistical analysis could not be performed due to the heterogeneity between studies.</p><p><strong>Results: </strong>A total of 148 studies were screened for inclusion in this systematic review and after full-text review, a total of 16 studies were included in this systematic review. Fourteen of the studies reported on pre- vs. postoperative PTS and all but one reported significant decrease in posterior tibial slope. Seven studies reported on pre- vs. postoperative PROs and all studies reported significant improvements in postoperative scores. Anterior tibial translation (ATT) was measured in 8 studies, and all reported a significant decrease in ATT postoperatively. The most common complication was postoperative hyperextension and hardware irritation. Hardware irritation was only reported in studies that used plates to fixate the osteotomy.</p><p><strong>Conclusions: </strong>In conclusion, slope reducing proximal tibial osteotomies performed concurrently or as a second stage surgery with an ACLR resulted in improved patient reported outcomes and decreased ACLR failure rates. Slope reducing proximal tibial osteotomies are an important treatment consideration for those patients with an increased PTS, especially for patients with a failed ACLR and a PTS ≥ 12° to reduce the risk of ACLR failure.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4000,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.arthro.2024.10.048","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: The purpose of this systematic review was to explore the indications, outcomes, and complications related to slope reducing osteotomies in the setting of anterior cruciate ligament (ACL) tears or graft failure. A secondary aim was to create an algorithm based on the current literature and authors' opinions.
Methods: This study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Studies were included if they reported on outcomes related to slope reducing osteotomies both for primary ACL tears and revision ACL graft tears. The studies were analyzed to determine the radiographic outcomes, patient reported outcomes (PROs), physical exam findings, and complications. Statistical analysis could not be performed due to the heterogeneity between studies.
Results: A total of 148 studies were screened for inclusion in this systematic review and after full-text review, a total of 16 studies were included in this systematic review. Fourteen of the studies reported on pre- vs. postoperative PTS and all but one reported significant decrease in posterior tibial slope. Seven studies reported on pre- vs. postoperative PROs and all studies reported significant improvements in postoperative scores. Anterior tibial translation (ATT) was measured in 8 studies, and all reported a significant decrease in ATT postoperatively. The most common complication was postoperative hyperextension and hardware irritation. Hardware irritation was only reported in studies that used plates to fixate the osteotomy.
Conclusions: In conclusion, slope reducing proximal tibial osteotomies performed concurrently or as a second stage surgery with an ACLR resulted in improved patient reported outcomes and decreased ACLR failure rates. Slope reducing proximal tibial osteotomies are an important treatment consideration for those patients with an increased PTS, especially for patients with a failed ACLR and a PTS ≥ 12° to reduce the risk of ACLR failure.
期刊介绍：
Nowhere is minimally invasive surgery explained better than in Arthroscopy, the leading peer-reviewed journal in the field. Every issue enables you to put into perspective the usefulness of the various emerging arthroscopic techniques. The advantages and disadvantages of these methods -- along with their applications in various situations -- are discussed in relation to their efficiency, efficacy and cost benefit. As a special incentive, paid subscribers also receive access to the journal expanded website.
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