Second Failure of ACL Graft: Third ACL Reconstruction Combined to Tibial Deflexion Osteotomy, A One Stage Procedure

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Introduction

Anterior cruciate ligament (ACL) revision rate is estimated at 12%. A tibial slope above 7° increases the anterior tibial translation (ATT) and has been identified as a risk factor of iterative rupture. The purpose of this study was to evaluate a third ACL reconstruction combined to tibial deflexion osteotomy in a one-stage procedure.

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Methods

It is a retrospective study of 11 ACL reconstructions combined to a tibial deflexion osteotomy in one stage procedure. The mean age at surgery was 36,2 years (26-42). The indication was clinical instability in daily life and recreational sport activities combined with tibial slope above 10°. The IKDC score, and Tegner and Lysholm score were used to evaluate the knee preoperatively and postoperatively. Preoperative and postoperative weight bearing X-Rays were done to evaluate the tibial slope

Results

IKDC and Tegner and Lyshom score increased respectively from 45,3 to 76,5 and from 40,8 to 75,6 at final follow-up (p

Conclusion

The tibial slope is an important factor to be measured in case of ACL rupture. A pathological tibial slope > 10° could lead to a stress rupture especially in case of meniscectomy. doing combined deflexion osteotomy and ACL reconstruction is an efficient procedure. The one stage procedure does not change the rehab protocol except a none weight bearing period of 21 days.

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