Slope reducing high tibial osteotomy and revision anterior cruciate ligament reconstruction leads to satisfying clinical results and a low failure rate

Purpose: This study aimed to assess clinical and radiological outcomes after two-staged slope-reducing high tibial osteotomy (HTO) and revision anterior cruciate ligament reconstruction (ACLR) for recurrent ACL insufficiency with an increased posterior tibial Slope (PTS) > 12°. Methods: Patients operated in two centres between 01/2015 and 01/2022 were included after a minimum follow-up of 24 months after revision ACLR. The postoperative pain and the following scores were obtained: IKDC, KOOS, Lysholm, TAS. The Slope was measured using the Dejour technique postoperatively using lateral X-rays being compared to a preoperative X-ray. Also, a clinical examination including range of motion, anterior + posterior translation and pivot-shift were performed. The Rolimeter was used for anterior tibial translation (ATT). Results: Twenty-four patients (18 m, 6 f; age: 27 ± 8 y) were examined after a mean follow-up of 34 ± 10 months. PTS was reduced from 15.2° ± 2.4° to 5.7° ± 3.8°. Scores at final follow-up: IKDC 75.5 ± 1.5, Lysholm 79.9 ± 12.7, KOOS 77.5 ± 11.5, TAS was 5 (interquartile range 4–7). Postoperative Pain was significantly reduced (VAS: 4.0 ± 2.8 vs. 1.4 ± 1.3; p < 0.001). Compared to the contralateral side, ATT was higher in the operated knee (2.5 ± 2.9 mm; p = <0.01). Four patients underwent revision surgery (2x non-traumatic instability; 2x traumatic ACL rupture). Additionally, 75% of patients returned to sports, while 64.3% of patients could return to their prior level. Conclusion: Combined slope-reducing HTO and ACLR lead to good clinical outcomes, high patient satisfaction, and a low failure rate. Patients were able to return to activity, but often at a lower sports level. Anterior tibial translation remains slightly increased compared to the healthy side. Level of Evidence: Therapeutic study Level IV, case series.