Is correctional osteotomy crucial in primary varus knees undergoing anterior cruciate ligament reconstruction?
BACKGROUND
Valgus high tibial osteotomy (HTO) has been recommended for ligament stability and enhanced function after anterior cruciate ligament (ACL) reconstruction in varus-angulated knees. However, it is not clear whether HTO should be performed in patients undergoing ACL reconstruction who have primary varus knees without medial compartment arthrosis.


OBJECTIVE
We therefore asked whether stability and function differed in patients having ACL reconstruction with differing degrees of preoperative alignment.


METHODS
We retrospectively reviewed 201 patients who had primary, single-bundle ACL reconstructions with primary varus knees based on the preoperative mechanical axis deviation (MAD) on preoperative standing hip-knee-ankle radiographs. Patients were categorized into four groups according to the MAD: Group 1: 0 mm to 4 mm, Group 2: 5 mm to 9 mm, Group 3: 10 mm to 14 mm, and Group 4: greater than 15 mm. A total of 201 patients, 67 in Group 1, 53 in Group 2, 38 in Group 3, and 43 in Group 4, were assessed. Ligament stability was determined with the Lachman test, pivot shift test, and KT 2000™ arthrometer. Functional scores were assessed using the Lysholm score and the International Knee Documentation Committee (IKDC) score. The minimum followup was 24 months (mean, 45 months; range, 24-96 months).


RESULTS
We observed no differences in the side-to-side KT 2000™ measurements, Lysholm score, or IKDC functional scores based on the preoperative MAD.


CONCLUSIONS
The stability and functional scores after ACL reconstruction were not adversely altered by primary varus alignment. Thus, if there is no medial compartment arthritis or varus thrust, we do not believe a correctional tibial osteotomy is crucial in primary varus knees undergoing ACL reconstruction.
Kim
Sung-Jae
SJ
Department of Orthopaedic Surgery and the Arthroscopy & Joint Research Institute, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul 120-752, Korea.
Moon
Hong-Kyo
HK
Chun
Yong-Min
YM
Chang
Woo-Hyuk
WH
Kim
Sul-Gee
SG
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D016118:Anterior Cruciate Ligament / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016025:Bone Transplantation / Q000009:adverse effects; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000209:etiology; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000009:adverse effects; D011859:Radiography; D020127:Recovery of Function; D056910:Republic of Korea; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult