Proximal Tibial Osteotomy and Revision ACL Reconstruction

Modern techniques for graft choice, preparation, and fixation for anterior cruciate ligament (ACL) reconstruction demonstrate excellent longevity and return-to-play rates; however, up to 10–18% of cases continue to suffer re-ruptures, with even higher rates in specific subsets of patients. In the setting of ACLR failure, a deflexion osteotomy of the proximal tibia may be necessary to lower the posterior tibial slope. Different techniques have been described to perform the osteotomy proximal to the tibial tubercle or in addition to a tibial tubercle osteotomy. In this chapter, the authors describe their preferred techniques for reduction of posterior tibial slope in the revision ACL reconstruction setting.