Wackerle Anja M, Marcaccio Stephen, Apseloff Nicholas, Getgood Alan, Musahl Volker, Tapasvi Sachin
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany.
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
J ISAKOS. 2025 Aug;13:100900. doi: 10.1016/j.jisako.2025.100900. Epub 2025 May 29.
The aim was to provide international guidelines to enhance decision-making regarding the definition and evaluation of increased posterior tibial slope (PTS) and the role of anterior closing wedge high tibial osteotomy (ACWHTO) in the setting of revision anterior cruciate ligament reconstruction (ACLR).
This guideline is based on responses from 46 international orthopaedic surgeons with expert experience in knee pathologies and osteotomy. Based on a literature review, each expert drafted and commented on a set of core statements. The provided comments were blinded and discussed within the working group to refine the statements. In a subsequent round of surveys, all experts discussed with the final 32 statements. Consensus was achieved when at least 80 % of survey respondents fully agreed.
With respect to ACWHTO for PTS reduction, there was consensus achieved for using the medial plateau as a measurement for PTS measuring, aiming for PTS correction of 5-7°, individualizing osteotomy wedge thickness, and performing ACWHTO and revision ACLR in a single stage. There was no consensus on the type of radiographs to be used, a cut-off value for increased PTS, an absolute indication for ACWHTO the osteotomy technique, nor type of fixation. The International consensus statements aim to bridge the gap between research and clinical application to enhance clinicians' decision-making in revision ACLR management and to focus future areas of required research.
The literature review confirmed a paucity of evidence to guide clinicians in the diagnosis and surgical management of increased PTS. An agreement could be achieved for 25/32 statements (78 %) on the definition and assessment of PTS, indication, planning, surgical decision-making, and peri- and postoperative management for ACWHTO. While no consensus could be achieved for the definition of a cut-off value for pathological PTS, consensus was reached for a variety of statements on diagnostic and surgical aspects.
V, expert opinion.
旨在提供国际指南，以加强关于胫骨后倾坡度（PTS）增加的定义和评估以及在翻修前交叉韧带重建（ACLR）中前闭合楔形高位胫骨截骨术（ACWHTO）作用的决策。
本指南基于46位在膝关节疾病和截骨术方面具有专业经验的国际骨科医生的回复。基于文献综述，每位专家起草并评论了一组核心声明。所提供的评论进行了盲法处理，并在工作组内进行讨论以完善声明。在随后的一轮调查中，所有专家对最终的32条声明进行了讨论。当至少80%的调查受访者完全同意时达成共识。
关于通过ACWHTO降低PTS，在以下方面达成了共识：使用内侧平台作为PTS测量的参照，目标是将PTS矫正5-7°，个体化截骨楔形厚度，以及在单一阶段进行ACWHTO和翻修ACLR。在使用的X线片类型、PTS增加的临界值、ACWHTO的绝对指征、截骨技术以及固定类型方面未达成共识。国际共识声明旨在弥合研究与临床应用之间的差距，以加强临床医生在翻修ACLR管理中的决策，并聚焦未来所需研究的领域。
文献综述证实，在指导临床医生对PTS增加的诊断和手术管理方面缺乏证据。在PTS的定义和评估、指征、规划、手术决策以及ACWHTO的围手术期和术后管理方面，32条声明中有25条（78%）达成了一致。虽然对于病理性PTS临界值的定义未能达成共识，但在诊断和手术方面的各种声明上达成了共识。
V，专家意见。
