# A Research Hotspot-Guided Meta-Analysis of Anterior Closing-Wedge High Tibial Osteotomy in Revision Anterior Cruciate Ligament Reconstruction

## TL;DR

This study combines bibliometric analysis and a meta-analysis to show that adjusting the posterior tibial slope improves outcomes in revision ACL surgery.

## Contribution

The novel approach integrates research trend analysis with clinical evidence to highlight posterior tibial slope as a key biomechanical factor in revision ACLR.

## Key findings

- Posterior tibial slope reduction of 8.72° was significantly achieved post-surgery.
- Patient-reported outcomes and knee stability improved significantly.
- Return-to-sport rate was 74%, with common complications including hardware issues and recurvatum.

## Abstract

Background: Revision anterior cruciate ligament reconstruction (ACLR) presents an increasing clinical challenge with higher failure rates than primary reconstruction. However, the evolving research landscape and clinical evidence regarding key biomechanical risk factors remain incompletely synthesized. Methods: A sequential dual methodological approach was applied. First, a bibliometric analysis of the Web of Science Core Collection was performed to map global research trends and identify emerging hotspots. Based on the identified hotspot, a PRISMA-compliant meta-analysis of studies retrieved from PubMed, Embase, the Cochrane Library, and Web of Science was subsequently conducted. Clinical and radiographic outcomes were synthesized using random-effects models in R. Results: The bibliometric analysis included 4213 publications and demonstrated exponential growth in revision ACLR research, identifying posterior tibial slope (PTS) as the dominant research hotspot. A meta-analysis of 11 studies involving 299 patients showed significant postoperative improvements in patient-reported outcomes and objective knee stability measures, along with a mean PTS reduction of 8.72° (95% CI 7.84–9.60; p < 0.001), while no significant change in patellar height was observed. The pooled return-to-sport rate was 74% (95% CI 64–82%), and the most common complications were symptomatic hardware and postoperative recurvatum. Conclusions: PTS has emerged as a key focus in revision ACLR research, and addressing this biomechanical factor may be associated with improved functional and radiographic outcomes. However, current evidence is mainly derived from retrospective studies, and further prospective research is needed to confirm long-term efficacy and refine surgical indications.