title: Long-term follow up of single-stage anterior cruciate ligament reconstruction and high tibial osteotomy and its relation with posterior tibial slope.
abstract: BACKGROUND
  Open-wedge high tibial osteotomy is considered to be an effective treatment for medial compartmental osteoarthritis. It is generally admitted that tibial slope increases after open-wedge high tibial osteotomy and decreases after closing-wedge high tibial osteotomy. Young patients with anterior cruciate ligament (ACL) deficiency along with medial compartment osteoarthritis need a combined procedure of ACL reconstruction along with high tibial osteotomy to regain physiological knee kinematics and to avoid chondral damage.
  
  
  METHODS
  We retrospectively analysed data from 30 patients who underwent arthroscopic ACL reconstruction along with medial opening-wedge osteotomy from Jan 2004 to June 2012 with a minimum follow up of 2 years. The pre-operative and post-operative posterior tibial slopes were measured. Functional outcome was analysed using clinico-radiological criteria, IKDC scoring and Lysholm score.
  
  
  RESULTS
  Post-operative patients improved both clinically and functionally. The patients who had posterior tibial slope >5° decrease, compared to patients who had less <5° decrease, had better functional scores (IKDC and Lysholm score), which was statistically significant (p < 0.05).
  
  
  CONCLUSIONS
  Our study has shown that decreasing the tibial slope >5° compared to pre-operative value has functionally favourable effect on the reconstructed ACL graft and outcome. It is known that increasing slope causes an anterior shift in tibial resting position that is accentuated under axial loads. This suggests that decreasing tibial slope may be protective in an ACL deficient knee. Hence by placing the tricortical graft posterior to midline in the opening wedge reduces the posterior tibial slope and thereby reduces the stress on the graft leading to better functional outcome.
authors.affiliation: Mysore Medical College, Mysore, Karnataka, India. drgrarun@gmail.com.|Ortho One Hospital, No-657, Singanallur, Coimbatore, 05, Tamil nadu, India. drgrarun@gmail.com.
authors.forename: G R
authors.initials: GR
authors.lastname: Arun
authors.affiliation: Kempegowda Institute of Medical Sciences, Bangalore, India.
authors.forename: Vinay
authors.initials: V
authors.lastname: Kumaraswamy
authors.affiliation: Ortho One Hospital, No-657, Singanallur, Coimbatore, 05, Tamil nadu, India.
authors.forename: David
authors.initials: D
authors.lastname: Rajan
authors.affiliation: Ortho One Hospital, No-657, Singanallur, Coimbatore, 05, Tamil nadu, India.
authors.forename: K
authors.initials: K
authors.lastname: Vinodh
authors.affiliation: Mayo Hospital, Lucknow, India.
authors.forename: Ashutosh Kumar
authors.initials: AK
authors.lastname: Singh
authors.affiliation: Ortho One Hospital, No-657, Singanallur, Coimbatore, 05, Tamil nadu, India.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Kumar
authors.affiliation: Ortho One Hospital, No-657, Singanallur, Coimbatore, 05, Tamil nadu, India.
authors.forename: Karthik
authors.initials: K
authors.lastname: Chandrasekaran
authors.affiliation: Ortho One Hospital, No-657, Singanallur, Coimbatore, 05, Tamil nadu, India.
authors.forename: Sahanand
authors.initials: S
authors.lastname: Santosh
authors.affiliation: Banares Hindu University, Varanasi, India.
authors.forename: Chandan
authors.initials: C
authors.lastname: Kishore
mesh_terms: D000328:Adult; D016118:Anterior Cruciate Ligament / Q000503:physiopathology / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D001182:Arthroscopy / Q000379:methods; D001696:Biomechanical Phenomena; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007718:Knee Injuries / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D012189:Retrospective Studies; D013977:Tibia / Q000033:anatomy & histology / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Anterior cruciate ligament reconstruction; High tibial osteotomy; IKDC score; Lysholm score