Lowe Walter R, Mansour Alfred, Higbie Steven, Galloway Connor, Kleihege Jacquelyn, Bailey Lane
Department of Orthopaedic Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA.
Department of Sports Medicine & Rehabilitation, Rockets Sports Medicine Institute, Memorial Hermann, Houston, Texas, USA.
Video J Sports Med. 2023 Sep 11;3(5):26350254231190938. doi: 10.1177/26350254231190938. eCollection 2023 Sep-Oct.
Increased posterior tibial slope is a strong predictor of anterior cruciate ligament (ACL) graft re-injury. A concomitant slope-reducing high tibial osteotomy (HTO) has been suggested to decrease re-tear risk in these cases although little is known regarding outcomes following ACL reconstruction with HTO, especially in elite athletic patients.
A 19-year-old National Collegiate Athletics Association (NCAA) Division 1 running back presented with an ACL tear, lateral meniscus tear, and posterior tibial slope of 19° (case 1). A 19-year-old NCAA Division 1 soccer forward presented with an ACL graft re-tear and posterior tibial slope of 21° (case 2).
Anterior closing wedge HTOs were performed along with a primary ACL reconstruction with quadriceps tendon autograft (case 1) and a revision ACL reconstruction with quadriceps tendon autograft (case 2). Following the arthroscopic procedures, an anterior approach was used to insert the first guide wire distal to the patellar tendon insertion from anterior to posterior aiming toward the posterior curve of the tibia. A second guide wire was placed at the previously templated distance. The osteotomy was then performed utilizing a saw and then osteotome. The reduction was performed by gently lifting the ankle anteriorly and applying axial pressure, and a new posterior tibial slope was calculated. After the osteotomy site was reduced, a preliminary reduction was performed by applying a clamp to both wires followed by placing a wire across the osteotomy site aiming from anterolateral to posteromedial. An anterolateral proximal tibial plate was applied, as well as a lag screw across the osteotomy site.
At 6 months after surgery, case 1 demonstrated >90% Limb Symmetry Indices (LSI) with quadriceps strength, single leg hop tests, and change of direction tests. At 12 months after surgery, case 2 demonstrated >90% LSI with all functional testing and competed in 17 games. Both patients returned to preinjury performance metrics including top speed and vertical jump height. No significant postoperative complications or instability was observed.
DISCUSSION/CONCLUSION: Primary or revision ACL reconstruction with HTO shows potential to assist athletes in returning to high-level sport while reducing posterior slope.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
胫骨后倾增加是前交叉韧带（ACL）移植物再次损伤的有力预测指标。对于此类情况，有人建议同时进行降低坡度的高位胫骨截骨术（HTO）以降低再次撕裂的风险，尽管对于采用HTO进行ACL重建后的结果知之甚少，尤其是在精英运动员患者中。
一名19岁的美国国家大学体育协会（NCAA）一级联赛跑卫出现ACL撕裂、外侧半月板撕裂，胫骨后倾19°（病例1）。一名19岁的NCAA一级联赛足球前锋出现ACL移植物再次撕裂，胫骨后倾21°（病例2）。
进行了前路闭合楔形HTO，同时进行了股四头肌肌腱自体移植的初次ACL重建（病例1）和股四头肌肌腱自体移植的ACL翻修重建（病例2）。关节镜手术后，采用前路入路从前向后在髌腱止点远端插入第一根导丝，使其朝向胫骨后曲线。在预先测量的距离处放置第二根导丝。然后使用锯子进行截骨，再用骨刀。通过轻轻向前抬起脚踝并施加轴向压力进行复位，并计算新的胫骨后倾角度。截骨部位复位后，通过对两根导丝施加夹子进行初步复位，然后从前外侧到后内侧在截骨部位放置一根导丝。应用胫骨近端前外侧钢板以及一枚穿过截骨部位的拉力螺钉。
术后6个月，病例1在股四头肌力量、单腿跳测试和变向测试中肢体对称指数（LSI）>90%。术后12个月，病例2在所有功能测试中LSI>90%，并参加了17场比赛。两名患者均恢复到受伤前的表现指标，包括最高速度和垂直跳跃高度。未观察到明显的术后并发症或不稳定情况。
讨论/结论：采用HTO进行初次或翻修ACL重建显示出有可能帮助运动员恢复高水平运动，同时降低后倾角度。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可能被识别，作者已随本稿件提交了患者的豁免声明或其他书面批准形式以供发表。
