Geers Katie, Ormseth Benjamin, Garrone Andrew, Siston Robert, Duerr Robert A
Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, Ohio, USA.
Jameson Crane Sports Medicine Institute, Department of Orthopedic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Video J Sports Med. 2021 Sep 1;1(5):26350254211022758. doi: 10.1177/26350254211022758. eCollection 2021 Sep-Oct.
Anterior cruciate ligament (ACL) ruptures are among the most common injuries in young athletes and active adults. Reconstruction of the ACL most often leads to good functional outcomes and return to full activities. However, a number of patients experience ACL graft failures requiring revision surgery. The reasons for ACL graft failure are often multifactorial, though recent attention has been given to elevated posterior tibial slope (PTS) as a risk factor for recurrent ACL injuries.
In patients with 2 or more ACL reconstruction failures with a PTS ≥12 degrees, anterior closing wedge proximal tibia osteotomy (ACWPTO) may be indicated to reduce the risk of recurrent ACL graft failure and allow return to full activities.
This surgical technique video demonstrates the ACWPTO using a case example in a young athlete. Preoperative templating on lateral radiograph is used to determine the amount of correction for the closing wedge. The osteotomy is completed using K-wires and a free hand biplanar cutting technique with the tibial tubercle left in place. This is performed with a concomitant revision ACL reconstruction using quadriceps tendon autograft.
There are 2 small cases series published with good clinical outcomes and return to sport activities. No ACL graft failures were reported in either study with short-term follow-up.
In this surgical technique video, we review the literature indicating elevated PTS as a risk factor in ACL injuries and recurrent ACL graft failures. We highlight important technique pearls and pitfalls to avoid complications during the surgical demonstration. Finally, we review postoperative rehabilitation guidelines and clinical outcomes within the existing literature. In patients with recurrent ACL graft failures, ACWPTO provides a safe and reliable technique to correct an elevated PTS and return patients back to full activities with reduced risk of ACL graft re-tear.
前交叉韧带（ACL）断裂是年轻运动员和活跃成年人中最常见的损伤之一。ACL重建术大多能带来良好的功能结果并使患者恢复全面活动。然而，一些患者会出现ACL移植物失败，需要进行翻修手术。ACL移植物失败的原因通常是多因素的，不过最近人们开始关注胫骨后倾坡度（PTS）升高是复发性ACL损伤的一个风险因素。
对于有2次或更多次ACL重建失败且PTS≥12度的患者，可能需要进行胫骨近端前闭合楔形截骨术（ACWPTO），以降低复发性ACL移植物失败的风险，并使患者能够恢复全面活动。
本手术技术视频通过一个年轻运动员的病例展示了ACWPTO。术前在侧位X线片上进行模板测量，以确定闭合楔形截骨的矫正量。使用克氏针和徒手双平面截骨技术完成截骨，保留胫骨结节。同时使用股四头肌肌腱自体移植物进行ACL翻修重建。
已发表了2个小病例系列，临床结果良好，患者恢复了体育活动。两项短期随访研究均未报告ACL移植物失败情况。
在本手术技术视频中，我们回顾了相关文献，这些文献表明PTS升高是ACL损伤和复发性ACL移植物失败的一个风险因素。我们强调了重要的技术要点和陷阱，以避免手术过程中出现并发症。最后，我们回顾了现有文献中的术后康复指南和临床结果。对于复发性ACL移植物失败的患者，ACWPTO提供了一种安全可靠的技术来矫正升高的PTS，并使患者能够恢复全面活动，降低ACL移植物再次撕裂的风险。
