Slope Change For ACL Deficiency

(0:00) Okay, so I'd like to talk to you about the slope (0:02) and I'll explain what that means. (0:04) So this is a very interesting case (0:06) that demonstrates why ACLs fail quite frequently. (0:11) So it's a 24 year old chap, very active, slim.

(0:14) He's a very high level badminton player. (0:17) He's had an ACL. (0:18) Initially good, then he feels bad.

(0:20) Very, very unstable. (0:22) He's struggling to walk actually. (0:23) His instability is so bad, (0:25) it's making it painful for him to walk (0:26) and he can't do any sports.

(0:28) So these are the short leg X-rays, (0:31) but let's look at his actual instability issue. (0:33) So look, he can do his own anterior draw. (0:36) This is a very bad prognosticator.

(0:39) He can also do his own sort of mimic a pivot shift. (0:43) You can see the knee flicking in and out. (0:45) This is very bad.

(0:46) This is the reason for this is his slope. (0:49) So we can see that here, (0:50) the slope from the front to the back is very high. (0:53) So we can draw two circles, connect those, connect those, (0:56) and we can calculate a slope of 18 degrees.

(0:59) Normal's about five. (1:01) So this gentleman's slope is way too high. (1:04) So we did the arthroscopy.

(1:06) I'm sorry, it's a little bit unclear, (1:08) but the ACL was fine, but the slope is high. (1:11) So what do we do? (1:12) Well, we went in, in fact, Christian did the surgery. (1:16) The wires go in, the four wires converging.

(1:19) So there's actually four there, not two. (1:21) The saw then goes in and we actually start (1:23) to saw out a wedge of bone and make a second cut upwards. (1:28) This is technically very, very difficult to do, (1:31) but we're leaving the extensor apparatus, (1:33) the way in which you make your leg go straight (1:36) is still completely attached, (1:37) which means you can recover much more quickly (1:39) with this technique.

(1:40) Again, we can see the milling of the bone from here (1:43) and now we've closed. (1:44) So when we've closed, we staple on one side, (1:47) we've developed a small plate with new clip (1:50) for the other side, and we have now a normalised slope. (1:54) So when we see the patient two weeks, (1:56) you'd think, you know, how much pain? (2:04) So we also did a ligament reconstruction on the side (2:08) for the slope change.

(2:13) So he can extend, he can bend it. (2:16) This is at two weeks. (2:18) This was easier for him to recover from (2:20) than his first ACL procedure, no pain.

(2:27) So this illustrates high slope. (2:30) And what I'm beginning to see in my practise (2:34) is every young person pretty much that comes to me, (2:38) who I measure the slope on is high. (2:40) And we know there's a 25% failure rate (2:43) in young children, adolescent and young people ACLs.

(2:46) And I think a lot of it's got to do with the slope. (2:49) But anyway, we're looking into that. (2:50) Bottom line is, if you've got an unstable knee (2:53) and you've had a bad result from an ACL, (2:54) the slope needs to be looked at (2:56) and it probably needs to be addressed.

(2:58) Anyway, come and see us if you have any issues (3:01) or come and visit us if you're a doctor (3:03) and join us in theatre. (3:04) Thank you very much.