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Title: [Clinical application of slope-reducing tibial osteotomy and anterior cruciate ligament revision in patients with abnormally increased posterior tibial slope].
Author: Nijiati Abulimiti, Li G, Sun X, Zhang K, Liu Y.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2022 Jan 15; 36(1):52-57. PubMed ID: 35038799.
Abstract:
OBJECTIVE: To investigate the effectiveness of slope-reducing tibial osteotomy and anterior cruciate ligament (ACL) revision in the treatment of patients with primary ACL reconstruction failure and abnormally increased posterior tibial slope (PTS). METHODS: The clinical data of 9 patients with primary ACL reconstruction failure and abnormally increased PTS (≥17°) who met the selection criteria between January 2018 and January 2020 were retrospectively analyzed. There were 8 males and 1 female; the age ranged from 21 to 42 years, with a median age of 30 years. Lachman test was positive in 9 patients. Pivot-shift test was negative in 6 cases, degree Ⅰ positive in 2 cases, and degree Ⅱ positive in 1 case. The PTS was (17.78±1.09)° and the anterior tibial translation (ATT) was (11.58±1.47) mm. The International Knee Documentation Committee (IKDC) score was 51.0±3.8, Lysholm score was 49.7±4.6, and Tegner score was 3.7±0.7. The time from primary reconstruction to revision was 12-33 months, with an average of 19.6 months. Slope-reducing tibial osteotomy and ACL revision were performed. The improvement of knee function was evaluated by IKDC score, Lysholm score, and Tegner score; Lachman test and Pivot-shift test were used to evaluate the stability of knee joint. PTS and ATT were measured to observe the morphological changes of knee joint. RESULTS: All the incisions healed by first intention, and there was no complication such as incision infection, fat liquefaction, necrosis, deep vein thrombosis of lower extremities, and neurovascular injury. All 9 patients were followed up 12-36 months, with an average of 25.8 months. At last follow-up, Lachman test and pivot-shift test were negative. IKDC score was 85.0±4.0, Lysholm score was 87.7±2.8, Tegner score was 6.8±0.7, PTS reduced to (9.89±0.60)°, and ATT shortened to (0.91±0.29) mm, which were significantly improved when compared with those before operation ( P<0.05). CONCLUSION: Slope-reducing tibial osteotomy and ACL revision in the treatment of patients with primary ACL reconstruction failure and abnormally increased PTS has a satisfactory short-term effectiveness. It can improve the stability of knee joint and maintain the normal shape of knee joint. 目的: 探讨胫骨去后倾化截骨加前交叉韧带（anterior cruciate ligament，ACL）翻修术治疗ACL初次重建术后失效合并胫骨平台后倾角（posterior tibial slope，PTS）异常增大患者的临床疗效。. 方法: 回顾分析2018年1月—2020年1月收治且符合选择标准的9例ACL初次重建术后失效合并PTS异常增大（≥17°）患者的临床资料。男8例，女1例；年龄21～42岁，中位年龄30岁。9例患者Lachman试验均为阳性；轴移试验阴性6例，Ⅰ度阳性2例，Ⅱ度阳性1例。PTS为（17.78±1.09）°、胫骨平台前移距离（anterior tibial translation，ATT）为（11.58±1.47）mm。国际膝关节文献委员会（IKDC）评分为（51.0±3.8）分，Lysholm评分为（49.7±4.6）分、Tegner评分为（3.7±0.7）分。初次重建至翻修时间为12～33个月，平均19.6个月。采用胫骨去后倾化截骨加ACL翻修术治疗。术后采用IKDC评分、Lysholm评分及Tegner评分评价膝关节功能改善情况，行Lachman试验、轴移试验评价膝关节稳定性，测量PTS及ATT观察膝关节形态学变化。. 结果: 术后切口均Ⅰ期愈合，未出现切口感染、脂肪液化、坏死以及下肢深静脉血栓形成、神经血管损伤等并发症。9例患者均获随访，随访时间12～36个月，平均25.8个月。末次随访时Lachman试验和轴移试验均为阴性。IKDC评分为（85.0±4.0）分、Lysholm评分为（87.7±2.8）分、Tegner评分为（6.8±0.7）分，PTS减小至（9.89±0.60）°，ATT缩短至（0.91±0.29）mm，与术前比较差异均有统计学意义（ P<0.05）。. 结论: 胫骨去后倾化截骨加ACL翻修术治疗ACL初次重建术后失效合并PTS异常增大患者早期临床疗效明确，在改善膝关节稳定性同时可较好地维持正常膝关节形态。.

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