caa a22 4500 605458316 CHVBK 20210128100228.0 cr unu---uuuuu 210128e20151001xx s 000 0 eng 10.1007/s00167-015-3758-6 doi (NATIONALLICENCE)springer-10.1007/s00167-015-3758-6 Tibial slope correction combined with second revision ACL produces good knee stability and prevents graft rupture [Elektronische Daten] [David Dejour, Mo Saffarini, Guillaume Demey, Laurent Baverel] Purpose: 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 2years, 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±4.4years (median 28; range 26-37), and mean follow-up was 4.0±2.0years (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). Conclusion: The satisfactory results of second revision ACL reconstruction combined with tibial deflexion osteotomy at minimum follow-up of 2years 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. Level of evidence: III. European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA), 2015 Anterior cruciate ligament nationallicence ACL failure nationallicence ACL revision nationallicence Posterior tibial slope nationallicence Tibial closed wedge osteotomy nationallicence Tibial deflexion osteotomy nationallicence Dejour David Lyon-Ortho-Clinic, Clinique de la Sauvegarde, 8 Avenue Ben Gourion, 69009, Lyon, France aut Saffarini Mo Accelerate Innovation Management SA, 1 Rue de la Navigation, 1201, Geneva, Switzerland aut Demey Guillaume Lyon-Ortho-Clinic, Clinique de la Sauvegarde, 8 Avenue Ben Gourion, 69009, Lyon, France aut Baverel Laurent Lyon-Ortho-Clinic, Clinique de la Sauvegarde, 8 Avenue Ben Gourion, 69009, Lyon, France aut Knee Surgery, Sports Traumatology, Arthroscopy Springer Berlin Heidelberg 23/10(2015-10-01), 2846-2852 0942-2056 23:10<2846 2015 23 167 https://doi.org/10.1007/s00167-015-3758-6 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00167-015-3758-6 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Dejour David Lyon-Ortho-Clinic, Clinique de la Sauvegarde, 8 Avenue Ben Gourion, 69009, Lyon, France aut NATIONALLICENCE 700 1- Saffarini Mo Accelerate Innovation Management SA, 1 Rue de la Navigation, 1201, Geneva, Switzerland aut NATIONALLICENCE 700 1- Demey Guillaume Lyon-Ortho-Clinic, Clinique de la Sauvegarde, 8 Avenue Ben Gourion, 69009, Lyon, France aut NATIONALLICENCE 700 1- Baverel Laurent Lyon-Ortho-Clinic, Clinique de la Sauvegarde, 8 Avenue Ben Gourion, 69009, Lyon, France aut NATIONALLICENCE 773 0- Knee Surgery, Sports Traumatology, Arthroscopy Springer Berlin Heidelberg 23/10(2015-10-01), 2846-2852 0942-2056 23:10<2846 2015 23 167