Summary
To compare functional performance and graft reinjury rates between patients undergoing ACL reconstruction surgery with a SRO versus matched controls undergoing isolated ACL reconstruction.
Abstract
Results
Of the 1,978 patients in the ACL registry, 48 met the study criteria and were included in the analyses (ACL+SRO group, n = 24; Isolated ACL group, n = 24). Baseline comparisons revealed that the ACL+SRO group was heavier (200.9 ±35.1 vs 179.7 ±33.9, P <.001) and as a result had a higher BMI (29.7 ±4.6 vs 26.7 ±5.0, P = .044), Table 1. Additional baseline differences included graft type, staged procedures and number of revision cases (P < .05, Table 2). The mean pre op posterior tibial slope was 17.0o ±2.7o and 7.0o ±2.2o following SRO (mean diff: -10.0o, P <.001). Table 3 depicts the comparisons at return to sport, with the ACL+SRO group demonstrating longer time to return (P < .001) and lower ACL-RSI scores (P = .027). At 2-years, there were no statistical differences in SANE score (85.3 ±7.3 vs 88.2 ±9.7, P = .349), graft reinjury rate (0.0% vs 0.0%, P = 1.000), rate of return to sport (85.7% vs 91.7%, P = .844), or level of return to sport between groups with 45.8% (n = 11) of the ACL+SRO group returning to a level I or II cutting and pivoting sport versus 54.2% (n = 13) in the Isolated ACL group (P = .656). There were no reported postoperative infections or deep vein thromboses in either group (P > .05).
Conclusion
The current study suggests that slope reducing SRO in the setting of ACL reconstruction for large posterior tibial slope deformities is effective at correcting malalignment, restoring objective and self-reported function, and avoiding graft failure out to 2 years. This procedure also holds promise to allow a majority of patients to return to various levels of sporting activities. To our knowledge, this is the first comparative study examining the return to sport and 2-year outcomes of this population to a matched isolated ACL cohort. While these data do provide evidence for ongoing investigation, it is important to note that this study is underpowered and we strongly recommend the performance of larger clinical trials to confirm these results.
Key Terms
Revision ACL reconstruction, posterior tibial slope, slope reducing osteotomy, graft retear
What is Known About the Subject
Increased posterior tibial slope is associated with ACL injury. There are only 6 case series reporting the results of anterior closing wedge osteotomy in the literature, and there have been no reported graft retears.
What this Study Adds to Existing Knowledge
This is the first study comparing the outcomes of revision ACL reconstruction and a slope reducing osteotomy with a matched control group. There were no graft retears at nearly two year follow up and no significant difference in patient reported outcomes. Furthermore, this is the first study to evaluate return to sport level, with the majority of patients being able to participate in level I through III sports.