{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T14:01:25Z","timestamp":1787061685665,"version":"build-2736575974"},"reference-count":21,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T00:00:00Z","timestamp":1766707200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T00:00:00Z","timestamp":1766707200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To compare infra\u2010tubercle (IKO) versus retro\u2010tubercle (RKO) slope\u2010reducing osteotomy performed with revision anterior cruciate ligament reconstruction (ACLR) on survivorship, anterior laxity, alignment, union, complications and patient\u2010reported outcome measures (PROMs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Retrospective comparative cohort at a tertiary centre including 107 consecutive revision ACLR\u2009+\u2009slope\u2010reducing osteotomy cases (IKO\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200950; RKO\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200957). Primary outcomes were Kaplan\u2013Meier survivorship for (1) revision\u2010only and (2) global failure (earliest of revision or instrumented anterior laxity &gt;\u20095\u2009mm). Secondary outcomes included Rolimeter side\u2010to\u2010side laxity at 2 months\/1 year\/2 years, radiographic posterior tibial slope (\u0394PTS) and hip\u2013knee\u2013ankle angle (\u0394HKA), union time, complications\/reoperations and knee injury and osteoarthritis outcome score (KOOS). Between\u2010group comparisons used\n                      <jats:italic>t<\/jats:italic>\n                      \u2010tests\/\n                      <jats:italic>\u03c7<\/jats:italic>\n                      \u00b2; survival was compared by the log\u2010rank test. Significance\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      At mean follow\u2010up of 27.9\u2009\u00b1\u20094.4 months, crude revision rates were 5.26% (3\/57; 95% confidence [CI]: 1.8%\u201314.4%) for IKO versus 20.0% (10\/50; 95% CI: 11.2%\u201333.0%) for RKO (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.048). Five\u2010year Kaplan\u2013Meier survivorship estimates showed no statistically significant differences at all endpoints. IKO demonstrated significantly lower instrumented laxity at all time points: 2.4\u2009\u00b1\u20092.1 versus 3.3\u2009\u00b1\u20092.0\u2009mm at 2 months (\n                      <jats:italic>p\u2009<\/jats:italic>\n                      =\u20090.034), 3.5\u2009\u00b1\u20092.3 versus 4.8\u2009\u00b1\u20092.7\u2009mm at 1 year (\n                      <jats:italic>p\u2009<\/jats:italic>\n                      =\u20090.010), and 4.0\u2009\u00b1\u20092.9 versus 5.8\u2009\u00b1\u20094.2\u2009mm at 2 years (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.013). Coronal alignment changes differed significantly between groups (\u0394HKA\u2009+\u20090.45\u00b0\u2009\u00b1\u20090.58\u00b0 for IKO vs. \u22121.32\u00b0\u2009\u00b1\u20091.20\u00b0 for RKO,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). PTS reduction was comparable between groups (\u0394PTS \u22128.20\u00b0\u2009\u00b1\u20091.61\u00b0, 95% CI: \u22128.6 to \u22127.8 vs. \u22127.90\u00b0\u2009\u00b1\u20091.74\u00b0, 95% CI: \u22128.4 to \u22127.4,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.35). Hardware removal was more frequent following IKO (38.8% vs. 17.2%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.016). Union was achieved universally in both groups, though healing time was longer after IKO (4.0\u2009\u00b1\u20090.9 vs. 3.2\u2009\u00b1\u20090.6 months,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In revision ACLR for elevated PTS, IKO and RKO yield comparable survivorship and PROM gains. IKO demonstrated better preservation of coronal\u2010plane alignment and lower residual anterior laxity, at the trade\u2010off of more frequent elective hardware removal and slightly longer time to union. These data can inform technique selection and counselling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level III, retrospective comparative cohort.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ksa.70250","type":"journal-article","created":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T11:04:41Z","timestamp":1766747081000},"page":"1024-1034","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Infra\u2010tubercle osteotomy preserves coronal alignment and reduces anterior laxity compared to retro\u2010tubercle technique in revision anterior cruciate ligament reconstruction with slope correction"],"prefix":"10.1002","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9813-4407","authenticated-orcid":false,"given":"Romir","family":"Patel","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, APHM, CNRS, ISM, Institute of Movement Sciences, Sainte\u2010Marguerite Hospital Aix Marseille University Marseille France"},{"name":"Department of Orthopaedic Surgery Massachusetts General Hospital Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Mabrouk","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, APHM, CNRS, ISM, Institute of Movement Sciences, Sainte\u2010Marguerite Hospital Aix Marseille University Marseille France"},{"name":"Trauma and Orthopaedics Department Basingstoke and North Hampshire Hospitals Basingstoke UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Souvik","family":"Paul","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, APHM, CNRS, ISM, Institute of Movement Sciences, Sainte\u2010Marguerite Hospital Aix Marseille University Marseille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4065-6049","authenticated-orcid":false,"given":"Christophe","family":"Jacquet","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, APHM, CNRS, ISM, Institute of Movement Sciences, Sainte\u2010Marguerite Hospital Aix Marseille University Marseille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6910-0873","authenticated-orcid":false,"given":"Matthieu","family":"Ollivier","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, APHM, CNRS, ISM, Institute of Movement Sciences, 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