High tibial osteotomy and ligament reconstruction for varus angulated anterior cruciate ligament-deficient knees.
In a consecutive series, we treated 41 young patients who had anterior cruciate ligament deficiency, lower limb varus angulation, and varying amounts of posterolateral ligament deficiency. Seventy-three percent of the patients (N = 30) had lost the medial meniscus and 63% (N = 26) had marked articular cartilage damage in the medial compartment. All patients were treated with high tibial osteotomy and, in the majority (N = 34), anterior cruciate ligament reconstruction a mean of 8 months later. Posterolateral reconstructions were also required in 18 knees. A 100% follow-up was obtained at a mean of 4.5 years after osteotomy. Gait analysis testing was done in 17 knees before and after osteotomy. At follow-up, a reduction in pain was found in 71% (29 knees); elimination of giving way, in 85% (35 knees); and resumption of light recreational activities without symptoms, in 66% (27 knees). The patient rating of the knee condition was normal or very good in 37% (15 knees) and good in 34% (14 knees). The mean Cincinnati Knee Rating Score significantly improved from 63 to 82 points. The mean adduction moment, 35% higher than controls preoperatively, significantly decreased to below normal values postoperatively. Correction of varus alignment was maintained in 33 knees (80%). We recommend osteotomy in addition to ligament reconstructive procedures in these knees with complex injury patterns.
Noyes
F R
FR
Cincinnati Sportsmedicine and Orthopaedic Center, Ohio, USA.
Barber-Westin
S D
SD
Hewett
T E
TE
D000293:Adolescent; D000328:Adult; D000465:Algorithms; D016118:Anterior Cruciate Ligament / Q000503:physiopathology / Q000601:surgery*; D002358:Cartilage, Articular / Q000637:transplantation; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005260:Female; D005684:Gait / Q000502:physiology; D006801:Humans; D016268:Internal Fixators; D007593:Joint Instability / Q000503:physiopathology / Q000601:surgery*; D007718:Knee Injuries / Q000503:physiopathology / Q000601:surgery*; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery*; D008023:Ligaments, Articular / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D011446:Prospective Studies; D013977:Tibia / Q000601:surgery*; D016896:Treatment Outcome