Tibial Supra-tubercular Deflexion Osteotomy in the Management of Failed Anterior Cruciate Ligament Reconstruction: A Surgical Technique

Jessica A Nelson; Dustin L Richter; Gehron Treme; Daniel Wascher; Lisandro Nardin; Robert C Schenck

doi:10.1016/j.eats.2022.03.032

Tibial Supra-tubercular Deflexion Osteotomy in the Management of Failed Anterior Cruciate Ligament Reconstruction: A Surgical Technique

Arthrosc Tech. 2022 Jul 14;11(8):e1425-e1430. doi: 10.1016/j.eats.2022.03.032. eCollection 2022 Aug.

Authors

Jessica A Nelson¹, Dustin L Richter¹, Gehron Treme¹, Daniel Wascher¹, Lisandro Nardin², Robert C Schenck¹

Affiliations

¹ University of New Mexico, Department of Orthopaedics and Rehabilitation, Albuquerque, New Mexico, U.S.A.
² Rosario, Argentina.

Abstract

Excessive posterior tibial slope (PTS) is a recognized risk factor for failure of anterior cruciate ligament reconstruction (ACLR) and should be considered when planning a revision ACLR. A tibial supra-tubercular deflexion osteotomy can correct excessive PTS with simultaneous or staged ACLR. There are only a handful of technical descriptions offering insight on the respective authors' approach at reducing PTS, all of which vary greatly in their methods. The authors describe a surgical technique using a proximal tibial supra-tubercular deflexion osteotomy in patients with persistent knee instability, a history of at least one failed ACLR, and a PTS greater than 12°. This surgery is not recommended in patients with significant genu recurvatum (>10°), significant varus, or severe tibiofemoral osteoarthritis.