Anterior Closing Wedge Tibial Osteotomy for Failed Anterior Cruciate Ligament Reconstruction

Failed reconstruction of the anterior cruciate ligament (ACL) in a young, active patient represents a difficult clinical problem. Numerous factors contribute to failure, including repeat trauma, technical errors, biologic influences, or a combination of causes. Technical errors commonly include femoral and tibial tunnel malposition, inadequate graft fixation, failure to address associated posteromedial or posterolateral corner injuries, and failure to correct coronal plane malalignment.1–7 Less commonly, sagittal plane malalignment can be a risk factor for ACL reconstruction failure.8 For an ACL deficient knee, each 10 degree increase in posterior tibial slope leads to a 6 mm increase in anterior tibial translation.9 Animal studies have also demonstrated that reduction of the tibial slope in the canine model leads to decreased anterior tibial translation.10 As a result, increased posterior slope poses a risk factor for failure of ACL reconstruction, or in the absence of a competent ACL, progressive posttraumatic arthritis.1,8 The purpose of this work is to describe the indications, technique, and short-term results of a slope decreasing, anterior closing wedge tibial osteotomy to address sagittal plane malalignment in revision ACL reconstruction. Case Report