Combined ACL reconstruction and closing-wedge HTO for varus angulated ACL-deficient knees.
OBJECTIVE
To report the medium-term clinical and radiographic outcomes of a group of patients who underwent anterior cruciate ligament (ACL) surgery combined with high tibial osteotomy (HTO) for varus-related early medial osteoarthritis (OA) and ACL deficiency knee.


METHODS
Thirty-two patients underwent single-bundle over-the-top ACL reconstruction or revision surgery and a concomitant closing-wedge lateral HTO. The mean age at surgery was 40.1 ± 8.1 years. Evaluation at a mean of 6.5 ± 2.7 years of follow-up consisted of subjective and objective IKDC, Tegner Activity Level, EQ-5D, VAS for pain and AP laxity assessment with KT-1000 arthrometer. Limb alignment and OA changes were evaluated on radiographs.


RESULTS
All scores significantly improved from pre-operative status to final follow-up. KT-1000 evaluation showed a mean side-to-side difference of 2.2 ± 1.0 mm. Two patients were considered as failures. The mean correction of the limb alignment was 5.6° ± 2.8°. Posterior tibial slope decreased at a mean of 1.2° ± 0.9°. At final follow-up, the mechanical axes crossed the medial-lateral length of tibial plateau at a mean of 56 ± 23 %, with only 1 patient (3 %) presenting severe varus alignment. OA progression was recorded only on the medial compartment (p = 0.0230), with severe medial OA in 22 % of the patients. No patients underwent osteotomy revision, ACL revision, UKA or TKA.


CONCLUSIONS
The described technique allowed patients with medial OA, varus alignment and chronic ACL deficiency to restore knee laxity, correct alignment and resume a recreational level of activity at 6.5 years of follow-up.
Clinica Ortopedica e Traumatologica II, Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10, 40136, Bologna, Italy. stefano.zaffagnini@biomec.ior.it
Stefano
S
Zaffagnini
Tommaso
T
Bonanzinga
Alberto
A
Grassi
Giulio Maria
GM
Marcheggiani Muccioli
Costanza
C
Musiani
Federico
F
Raggi
Francesco
F
Iacono
Vittorio
V
Vaccari
Maurilio
M
Marcacci
D000328:Adult; D059549:Anterior Cruciate Ligament Reconstruction; D053587:Arthrometry, Articular; D060750:Bone Anteversion / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000601:surgery; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000145:classification / Q000503:physiopathology / Q000601:surgery; D010027:Osteotomy / Q000379:methods*; D011859:Radiography; D012720:Severity of Illness Index; D013709:Tendon Transfer; D013977:Tibia / Q000601:surgery*; D016896:Treatment Outcome