Osteotomy for malalignment following failed ACL reconstruction

Abstract

Failed anterior cruciate ligament reconstruction represents a challenge in orthopedics and surgeons are often compelled to face many different complicated clinical situations. No decision-making algorithms are available regarding tibial osteotomy and ACL revision and every case must be carefully studied and planned. Even though little evidence is available regarding high tibial osteotomy (HTO) and ACL revision, the importance of limb alignment is widely accepted, and even though HTO is almost never indicated in malaligned knees with acute ACL tear, malalignment is a widely recognized cause of ACL failure. The aim of this chapter is to describe the indications for osteotomies in ACL revision surgery, the patient's history and examination, the preoperative planning, and the surgical techniques in order to allow surgeons to better understand the goals that should be achieved in ACL revision surgery.