Coronal Malalignment and Revision Anterior Cruciate Ligament Reconstruction

Paul M. Incan, Matthew J. Matava

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review


Consideration of lower limb alignment is an important component of the evaluation of patients with a failed anterior cruciate ligament (ACL) reconstruction. Malalignment in the coronal plane can be anatomically normal or an acquired deformity resulting from medial or lateral cartilage loss. Coronal malalignment can place excessive tensile stress on the ACL graft as well as increased compressive load on the medial or lateral compartment, ultimately leading to failure of the ACL reconstruction. Therefore, coronal plane malalignment must be addressed in order to protect the ACL graft and reduce and alleviate symptoms secondary to uni-compartmental osteoarthritis. Varus malalignment is addressed with a proximal (“high”) tibial osteotomy, whereas valgus deformity is corrected with a distal femoral osteotomy. This chapter will address the relevance of coronal plane malalignment, as well as the technical issues encountered when performing a revision ACL reconstruction and osteotomy in patients with both ACL insufficiency and malalignment.

Original languageEnglish
Title of host publicationRevision Anterior Cruciate Ligament Reconstruction
Subtitle of host publicationA Case-Based Approach
PublisherSpringer International Publishing
Number of pages35
ISBN (Electronic)9783030969967
ISBN (Print)9783030969950
StatePublished - Jan 1 2022


  • ACL
  • Coronal
  • Malalignment
  • Osteotomy
  • Revision


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