- Design
- Retrospective two-centre case series (level 4)
- Population
- 19 elite athletes with failed ACL reconstruction and tibial slope ≥10°
- Primary outcome
- Return to pre-injury level of sport
- Effect
- 19/19 returned at a mean of 12.1 months; no graft failures at mean 58.8 months
This retrospective case series from two centres included 19 elite athletes with a failed ACL reconstruction and a posterior tibial slope of 10° or more, treated with revision reconstruction plus a supratuberosity slope-reducing osteotomy between 2011 and 2023.
All 19 returned to competition at their previous level, after a mean of about 12 months. Knee scores rose substantially (IKDC from 44 to 92; Lysholm from 47 to 97), and mean slope fell from about 15° to 4.5°. Over a mean follow-up of nearly five years there were no graft failures or major complications; the only reoperations were staple removals.
High tibial slope is an established risk factor for graft failure, and this series shows that correcting it alongside revision can be done safely in demanding patients. But it is uncontrolled, small and from expert centres, so it cannot say how much of the result came from the osteotomy rather than the revision.
- Measure posterior tibial slope on a true lateral radiograph in every failed ACL reconstruction.
- Consider slope-reducing osteotomy at revision when slope is 10° or more and no other cause of failure explains it.
- Warn athletes that return to sport after combined surgery took about a year in this series.
- Refer to a centre experienced in osteotomy rather than attempting it occasionally.
Why it matters
Repeating the same reconstruction without addressing slope may repeat the same failure.
Don't overread it
A 19-patient case series without a control group cannot show that the osteotomy caused the good outcomes.
The statistics, in plain English
With 19 patients and no comparison group, the 100% return-to-sport figure is encouraging but could change greatly in a larger series. The confidence intervals around the score changes are wide, which reflects the small sample.
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