title: The short-term outcome of surgical treatment for painful varus arthritis in association with chronic ACL deficiency.
abstract: A review of patients with anterior cruciate ligament (ACL) insufficiency, symptomatic medial compartment osteoarthritis, and varus malalignment of the knee was performed. Twenty-six patients met the inclusion criteria. Twelve patients were treated with a valgus closing-wedge high tibial osteotomy (group 1). Fourteen patients were treated with a valgus closing-wedge high tibial osteotomy combined with arthroscopic ACL reconstruction (group 2). Twenty-five patients were available for follow-up at a minimum of 2 years. For group 1 patients, high tibial osteotomy alone had no effect on the Lachman test or pivot shift phenomena. For group 2 patients, combined high tibial osteotomy/ACL reconstruction resulted in a grade 1 Lachman test in 11 of 13 patients, and a negative pivot shift in 12 of 13 patients. No deficits in range of motion were noted in either group. Prior to surgery, 14 (56%) patients participated in recreational sports; 23 (92%) patients were able to participate in recreational sports at follow-up. Radiographs demonstrated osteoarthritic progression in group 1 and 2 patients (P<.05). The results of this study suggest that high tibial osteotomy alone and combined high tibial osteotomy/ACL reconstructions are effective in the surgical treatment of varus, ACL-deficient knees with symptomatic medial compartment arthritis; however, good or excellent results were more often seen after the combined procedure.
authors.affiliation: Sports Medicine and Shoulder Service, Hospital for Special Surgery-Cornell University Medical Center New York, NY, USA.
authors.forename: Riley J
authors.initials: RJ
authors.lastname: Williams
authors.forename: Bryan T
authors.initials: BT
authors.lastname: Kelly
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Wickiewicz
authors.forename: David W
authors.initials: DW
authors.lastname: Altchek
authors.forename: Russell F
authors.initials: RF
authors.lastname: Warren
mesh_terms: D000328:Adult; D016118:Anterior Cruciate Ligament / Q000503:physiopathology* / Q000601:surgery*; D001182:Arthroscopy / Q000379:methods; D017760:Bone Malalignment / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000601:surgery; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000503:physiopathology / Q000601:surgery*; D010027:Osteotomy / Q000379:methods; D010146:Pain / Q000503:physiopathology / Q000601:surgery*; D017060:Patient Satisfaction; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology; D012086:Reoperation; D012189:Retrospective Studies; D013977:Tibia / Q000601:surgery; D016896:Treatment Outcome