title: Prospective study of the anterior cruciate ligament reconstruction associated with high tibial opening wedge osteotomy in knee arthritis associated with instability.
abstract: BACKGROUND
  Chronic ACL insufficiency with associated varus malalignment due to knee osteoarthritis (OA) is challenging to treat surgically. A combined ACL reconstruction (ACLR) with medial open wedge high tibial osteotomy (HTO) without using any metallic implant for HTO is an effective technique.
  
  
  METHODS
  All the patients attending the outpatient department ACL injury and with associated medial compartment OA (Kellegren's grade 2 and grade 3) were considered for inclusion in the study. Forty patients who met inclusion criteria were included in the study. Simultaneous ACLR (single bundle of quadrupled hamstring graft fixed with Endobutton on femoral side and biointerference screw on the tibial side) along with medial opening wedge osteotomy (with tricalcium phosphate wedge) was done. The patients were assessed with IKDC, KOOS scores and any change in anterior tibial translation was also checked.
  
  
  RESULTS
  The combined procedure showed mean varus angle correction of 9° (10.5-1.5°), and the mechanical axis of the knee was restored from an average of 172-181.5°. There was a significant improvement in knee score (KOOS and IKDC) after the surgery (p< 0.05). The average time for the radiological union of the osteotomy was 3.56 months. The anterior tibial translation was improved. No intraoperative complications and slippage of the synthetic graft were noted in any case.
  
  
  CONCLUSIONS
  Combined ACLR with HTO (using TCP wedge, without any hardware) is a reliable method that prevents rapid progression of OA. It reliably corrects varus deformity and obviates the use of any hardware.
authors.affiliation: Department of Orthopaedics, Joint Replacement & Arthroscopy, Indraprastha Apollo Hospital, New Delhi 110076, India.
authors.forename: Raju
authors.initials: R
authors.lastname: Vaishya
authors.affiliation: Department of Orthopaedics, Joint Replacement & Arthroscopy, Indraprastha Apollo Hospital, New Delhi 110076, India.
authors.forename: Vipul
authors.initials: V
authors.lastname: Vijay
authors.affiliation: Department of Orthopaedics, Joint Replacement & Arthroscopy, Indraprastha Apollo Hospital, New Delhi 110076, India.
authors.forename: Gyanendra Kumar
authors.initials: GK
authors.lastname: Jha
authors.affiliation: Department of Orthopaedics, Joint Replacement & Arthroscopy, Indraprastha Apollo Hospital, New Delhi 110076, India.
authors.forename: Amit Kumar
authors.initials: AK
authors.lastname: Agarwal
keywords: Anterior cruciate ligament; High tibial osteotomy; Knee; Osteoarthritis