While often successful, anterior cruciate ligament surgery sometimes does fail. What we’ve seen is that failure can be caused by various factors, including technical, anatomic, and patient-related factors. The shape of the knee joint is one of those anatomic factors, specifically an increased posterior tibial slope. This factor is associated with an increased risk of failure, both after primary and revision ACL reconstruction. We believe that this is a result of increased load across the ACL graft.
To address this surgically, we recommend this surgical technique: using staple fixation. Our technique is a combined, single-stage, all-inside reconstruction of the ACL and an anterior closing-wedge osteotomy. The technique we propose in this article and video provides adequate fixation of the osteotomy while also minimizing hardware interference with the ACL tunnel placement and maximizing the proximal femoral bone stock.
To learn more about this staple fixation surgical technique, read the complete article in Arthroscopy Techniques and watch the included video: Combined All-Inside Anterior Cruciate Ligament Reconstruction and Tibial Anterior Closing Wedge Tibial Osteotomy Using Staple Fixation: Surgical Technique.
The image in this post is taken from the video.