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Tibial slope correction combined with second revision ACLR grants good clinical outcomes and prevents graft rupture at 7–15-year follow-up

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To update previously published outcomes (at 2–8 years) of second revision anterior cruciate ligament reconstruction (ACLR) combined with tibial deflexion osteotomy (TDO), after an interval of 5 more years (at 7–15 years), and monitor evolution of clinical scores and progression of osteoarthritis.

Methods

The initial retrospective consecutive series included nine patients that underwent one-stage second revision ACLR with TDO, all of whom were contacted for second follow-up at minimum 7 years. An independent observer collected IKDC-SKF, the Lysholm score, and assessed radiographs for signs of osteoarthritis.

Results

Of the nine original patients, seven were assessed at the clinic, one could only be assessed by telephone, and one was lost to follow-up. At final follow-up of 9.9 ± 3.0 years, the eight patients assessed maintained or improved clinical scores, compared to the previous follow-up at 4.0 ± 2.9 years. The mean Lysholm score improved from 73.8 ± 5.8 (65–82) to 84.5 ± 11.9 (59–95), and IKDC improved from 71.6 ± 6.2 (62–79) to 82.9 ± 12.1 (61–98). Of the three patients that had signs of arthritis at the previous follow-up, the stage of osteoarthritis increased in one (from grade 2 to grade 3), remained unchanged in one, and could not be assessed in one.

Conclusion

At 7–15 years following second revision ACLR with TDO, patients maintained or improved clinical scores compared to the previous follow-up at 2–8 years, without retears or reoperations. Although eight of the nine knees had meniscectomies or meniscal sutures, osteoarthritis progressed in only one of the six knees that had signs of arthritis at the previous follow-up. These results confirm that TDO can protect the ACL graft from retear, with minimal progression of osteoarthritis and/or risks of meniscal tears, suggesting that correction of excessive tibial slope should be considered when performing ACLR, whether a revision or primary procedure.

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References

  1. Agneskirchner JD, Hurschler C, Stukenborg-Colsman C, Imhoff AB, Lobenhoffer P (2004) Effect of high tibial flexion osteotomy on cartilage pressure and joint kinematics: a biomechanical study in human cadaveric knees. Winner of the AGA-DonJoy Award 2004. Arch Orthop Trauma Surg 124(9):575–584

    Article  CAS  Google Scholar 

  2. Akoto R, Alm L, Drenck TC, Frings J, Krause M et al (2020) Slope-correction osteotomy with lateral extra-articular tenodesis and revision anterior cruciate ligament reconstruction Is highly effective in treating high-grade anterior knee laxity. Am J Sports Med 48(14):3478–3485

    Article  Google Scholar 

  3. Barenius B, Ponzer S, Shalabi A, Bujak R, Norlén L et al (2014) Increased risk of osteoarthritis after anterior cruciate ligament reconstruction: a 14-year follow-up study of a randomized controlled trial. Am J Sports Med 42(5):1049–1057

    Article  Google Scholar 

  4. Bernhardson AS, Aman ZS, Dornan GJ, Kemler BR, Storaci HW et al (2019) Tibial slope and Its effect on force in anterior cruciate ligament grafts: anterior cruciate ligament force increases linearly as posterior tibial slope increases. Am J Sports Med 47(2):296–302

    Article  Google Scholar 

  5. Brandon ML, Haynes PT, Bonamo JR, Flynn MI, Barrett GR et al (2006) The association between posterior-inferior tibial slope and anterior cruciate ligament insufficiency. Arthroscopy 22(8):894–899

    Article  Google Scholar 

  6. Christensen JJ, Krych AJ, Engasser WM, Vanhees MK, Collins MS et al (2015) Lateral tibial posterior slope is Increased in patients with early graft failure after anterior cruciate ligament reconstruction. Am J Sports Med 43(10):2510–2514

    Article  Google Scholar 

  7. Dejour D, Khun A, Dejour H (1998) Osteotomie tibiale de déflexion et laxité chronique antérieure à propos de 22 cas. Rev Chir Orthop 84:28–29

    Google Scholar 

  8. Dejour D, Saffarini M, Demey G, Baverel L (2015) Tibial slope correction combined with second revision ACL produces good knee stability and prevents graft rupture. Knee Surg Sports Traumatol Arthrosc 23(10):2846–2852

    Article  Google Scholar 

  9. Dejour D, Vanconcelos W, Bonin N, Saggin PR (2013) Comparative study between mono-bundle bone-patellar tendon-bone, double-bundle hamstring and mono-bundle bone-patellar tendon-bone combined with a modified Lemaire extra-articular procedure in anterior cruciate ligament reconstruction. Int Orthop 37(2):193–199

    Article  Google Scholar 

  10. Dejour H, Bonnin M (1994) Tibial translation after anterior cruciate ligament rupture. Two radiological tests compared. J Bone Joint Surg Br 76(5):745–749

    Article  CAS  Google Scholar 

  11. Dini F, Tecame A, Ampollini A, Adravanti P (2019) Multiple ACL revision: failure analysis and clinical outcomes. J Knee Surg 34(8):801–809

    PubMed  Google Scholar 

  12. Engler ID, Salzler MJ, Wall AJ, Johnson WR, Makani A et al (2020) Patient-reported outcomes after multiple-revision ACL reconstruction: good but not great. Arthrosc Sports Med Rehabil 2(5):e539–e546

    Article  Google Scholar 

  13. Giffin JR, Vogrin TM, Zantop T, Woo SL, Harner CD (2004) Effects of increasing tibial slope on the biomechanics of the knee. Am J Sports Med 32(2):376–382

    Article  Google Scholar 

  14. Grassi A, Ardern CL, Marcheggiani Muccioli GM, Neri MP, Marcacci M et al (2016) Does revision ACL reconstruction measure up to primary surgery? A meta-analysis comparing patient-reported and clinician-reported outcomes, and radiographic results. Br J Sports Med 50(12):716–724

    Article  Google Scholar 

  15. Grassi A, Kim C, Marcheggiani Muccioli GM, Zaffagnini S, Amendola A (2017) What Is the mid-term failure rate of revision ACL reconstruction? A systematic review. Clin Orthop Relat Res 475(10):2484–2499

    Article  Google Scholar 

  16. Griffith TB, Allen BJ, Levy BA, Stuart MJ, Dahm DL (2013) Outcomes of repeat revision anterior cruciate ligament reconstruction. Am J Sports Med 41(6):1296–1301

    Article  Google Scholar 

  17. Hamrin Senorski E, Svantesson E, Baldari A, Ayeni OR, Engebretsen L et al (2019) Factors that affect patient reported outcome after anterior cruciate ligament reconstruction—a systematic review of the Scandinavian knee ligament registers. Br J Sports Med 53(7):410–417

    Article  Google Scholar 

  18. Horvath A, Senorski EH, Westin O, Karlsson J, Samuelsson K et al (2019) Outcome after anterior cruciate ligament revision. Curr Rev Musculoskelet Med 12(3):397–405

    Article  Google Scholar 

  19. Imhoff FB, Mehl J, Comer BJ, Obopilwe E, Cote MP et al (2019) Slope-reducing tibial osteotomy decreases ACL-graft forces and anterior tibial translation under axial load. Knee Surg Sports Traumatol Arthrosc 27(10):3381–3389

    Article  Google Scholar 

  20. Keays SL, Newcombe PA, Bullock-Saxton JE, Bullock MI, Keays AC (2010) Factors involved in the development of osteoarthritis after anterior cruciate ligament surgery. Am J Sports Med 38(3):455–463

    Article  Google Scholar 

  21. Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16(4):494–502

    Article  CAS  Google Scholar 

  22. Lefevre N, Klouche S, Mirouse G, Herman S, Gerometta A et al (2017) Return to sport after primary and revision anterior cruciate ligament reconstruction: a prospective comparative study of 552 patients from the FAST cohort. Am J Sports Med 45(1):34–41

    Article  Google Scholar 

  23. Napier RJ, Garcia E, Devitt BM, Feller JA, Webster KE (2019) Increased radiographic posterior tibial slope Is associated with subsequent injury following revision anterior cruciate ligament reconstruction. Orthop J Sports Med 7(11):2325967119879373

    Article  Google Scholar 

  24. Ogura T, Ackermann J, Barbieri Mestriner A, Merkely G, Gomoll AH (2020) Minimal clinically important differences and substantial clinical benefit in patient-reported outcome measures after autologous chondrocyte implantation. Cartilage 11(4):412–422

    Article  CAS  Google Scholar 

  25. Salmon LJ, Heath E, Akrawi H, Roe JP, Linklater J et al (2018) 20-year outcomes of anterior cruciate ligament reconstruction with hamstring tendon autograft: the catastrophic effect of age and posterior tibial slope. Am J Sports Med 46(3):531–543

    Article  Google Scholar 

  26. Shelburne KB, Kim HJ, Sterett WI, Pandy MG (2011) Effect of posterior tibial slope on knee biomechanics during functional activity. J Orthop Res 29(2):223–231

    Article  Google Scholar 

  27. Sonnery-Cottet B, Mogos S, Thaunat M, Archbold P, Fayard JM et al (2014) Proximal tibial anterior closing wedge osteotomy in repeat revision of anterior cruciate ligament reconstruction. Am J Sports Med 42(8):1873–1880

    Article  Google Scholar 

  28. Winkler PW, Godshaw BM, Karlsson J, Getgood AMJ, Musahl V (2021) Posterior tibial slope: the fingerprint of the tibial bone. Knee Surg Sports Traumatol Arthrosc 29:1687–1689

    Article  Google Scholar 

  29. Winkler PW, Wagala NN, Hughes JD, Lesniak BP, Musahl V (2021) A high tibial slope, allograft use, and poor patient-reported outcome scores are associated with multiple ACL graft failures. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-021-06460-8

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

The authors are grateful to “GCS Ramsay Santé pour l’Enseignement et la Recherche” for funding the statistical analysis and manuscript preparation for this study.

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Authors and Affiliations

  1. Lyon-Ortho-Clinic, Clinique de la Sauvegarde, Ramsay Santé, 29 Avenue des Sources, 69009, Lyon, France

    Anouk Rozinthe, Guillaume Demey & David Dejour

  2. ReSurg SA, Rue Saint Jean 22, 1260, Nyon, Switzerland

    Floris van Rooij & Mo Saffarini

Authors
  1. Anouk Rozinthe
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  2. Floris van Rooij
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  3. Guillaume Demey
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  4. Mo Saffarini
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  5. David Dejour
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Corresponding author

Correspondence to Floris van Rooij.

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Conflicts of interest

AR has nothing to declare. FVR has nothing to declare. GD has nothing to declare. MS has nothing to declare. Dr. Dejour reports personal fees from SBM, outside the submitted work.

Ethical approval

All patients had provided written informed consent for the use of their data and images for research and publishing purposes and the institutional review board approved the study in advance (GCS Ramsay Santé pour l'Enseignement et la Recherche, COS-RGDS-2021-03-008-DEJOUR-D).

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Rozinthe, A., van Rooij, F., Demey, G. et al. Tibial slope correction combined with second revision ACLR grants good clinical outcomes and prevents graft rupture at 7–15-year follow-up. Knee Surg Sports Traumatol Arthrosc 30, 2336–2341 (2022). https://doi.org/10.1007/s00167-021-06750-1

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