Slope-Reducing Osteotomy Accompanied by Revision Anterior Cruciate Ligament Reconstruction Improves Knee Stability and Function: A Systematic Review and Meta-analysis

To investigate the clinical and radiographic outcomes of revision anterior cruciate ligament reconstruction (rACLR) combined with anterior closing-wedge high tibial osteotomy (ACWHTO) for posterior tibial slope (PTS) reduction. We performed a systematic search across multiple databases, including Scopus, MEDLINE via PubMed, Web of Science, CINAHL, SPORTDiscus, Cochrane, and Embase, to identify all articles published before August 2, 2024. Pre- and postoperative outcomes, complications, and surgical characteristics were investigated. Studies with a mean follow-up under 24&#x2009;months were excluded for meta-regression and meta-analysis. Statistical analysis was conducted using the Stata software, and the risk of bias was assessed using the Risk of Bias in Nonrandomized Studies of Interventions, version 2 tool. This systematic review included 11 studies (267 patients); however, only 8 studies (190 patients) with a mean follow-up of 24&#x2009;months were included in the final analysis. Statistically significant improvements in PTS (8.40&#xb0;), International Knee Documentation Committee score, Lysholm score, and anterior tibial translation were observed following slope reduction surgery (P&#x2009;<&#x2009;.001 for all). Patellar height, the Tegner activity scale, and the risk of osteoarthritis showed no significant changes pre- and postoperatively. The pooled risk difference for pivot shift was significantly reduced after surgery (P&#x2009;<&#x2009;.001). Subgroup analysis showed that supratubercular ACWHTO resulted in a significantly greater reduction in PTS compared with transtubercular ACWHTO (9.31&#xb0; vs 4.41&#xb0;, P&#x2009;<&#x2009;.001). Meta-regression analysis of the effect of different variables on functional and radiological outcomes did not show any significant results. Revision anterior cruciate ligament reconstruction combined with ACWHTO significantly improves PTS and anterior tibial translation, enhancing knee stability and functional outcomes. These results support incorporating ACWHTO when indicated. Level IV, systematic review and meta-analysis of level IV studies.