Combined revision ACL reconstruction with slope‐correction osteotomy and lateral extra‐articular tenodesis improves stability in patients with high posterior tibial slope and pivot shift
Bibliographic record
Abstract
Abstract Purpose The purpose of this study was to evaluate the outcomes of patients undergoing single‐stage revision anterior cruciate ligament (ACL) reconstruction (ACLR) with bone‐patellar tendon‐bone (BPTB) autograft, anterior closing wedge proximal tibial osteotomy (ACWPTO) and lateral extra‐articular tenodesis (LET). Methods An institutional review board‐approved retrospective study of all patients who underwent a revision ACLR using a BPTB autograft, ACWPTO and LET from a single centre from 2018 to 2023 was performed. Inclusion criteria were patients >18 years of age with a failed ACLR, posterior tibial slope (PTS) of >15°, previous ACL‐tunnel diameters of <14 mm, and intact ipsilateral patellar tendon. PTS and anterior tibial translation (ATT) were measured using the mechanical axis on long weight‐bearing lateral tibial radiographs. Results Nine patients, all men, were evaluated with a mean age of 31.1 years and a mean follow‐up of 31.4 months. The PTS significantly decreased from 16.8° (range: 15.1°–18.9°) preoperatively to 9.3° (range: 5.0°–14.7°) post‐operatively ( p < 0.001) and ATT significantly decreased from 14.6 mm (range: 10.7–19.0 mm) preoperatively to 6.3 mm (range: 1.3–11.5 mm) post‐operatively ( p < 0.001). Preoperatively, all patients showed significant instability with the Lachman test Grade 2/3 and the pivot shift test Grade 2/3. Post‐operatively, Lachman test grade was 0 and Pivot shift test grade was 0 in all patients ( p < 0.01), and the average post‐operative subjective International Knee Documentation Committee (IKDC) score was 79.4 (range: 60.9–95.4). Conclusions Single‐stage revision ACLR using BPTB autograft, ACWPTO and LET in an ACL‐deficient knee with high‐grade pivot shift and increased PTS was safe and reliable, with significantly improved clinical and objective outcomes. Level of Evidence Level IV, case series.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".