title: ACL deficiency and varus osteoarthritis: high tibial osteotomy alone or combined with ACL reconstruction?
abstract: BACKGROUND
  This study investigates the mid- to long-term clinical and radiological outcome in patients with symptomatic varus osteoarthritis (OA) and deficiency of the anterior cruciate ligament (ACL) and analyzes whether there are differences between isolated high tibial osteotomy (HTO) or combined single-stage HTO and ACL reconstruction (ACLR).
  
  
  METHODS
  26 patients who underwent HTO alone (group 1) and 26 patients who underwent single-stage HTO and ACLR (group 2) because of varus OA and ACL deficiency were examined at a mean of 5.8 years (SD 3.6 years) post-operatively. Assessment at follow-up (FU) was performed using a questionnaire including clinical scores (Lysholm, IKDC) and the KT-2000 arthrometer to examine anterior knee stability. Radiographic knee alignment and signs of OA according to the classification of Kellgren and Lawrence (KL) were assessed pre-operatively and at FU.
  
  
  RESULTS
  Eighty-one percent of all patients reported an improvement of pain and 79% an improvement of instability without significant group difference. Significant worse results were observed in group 1 for the Lysholm score (group 1: 69.4, SD 15.7; group 2: 78.3, SD 16.4; p = 0.020) and the IKDC score (group 1: 64.8, SD 13.0; group 2: 74.0, SD 15.6; p = 0.006). No group difference was found for the KT-2000 examination. A significant post-operative increase of radiographic OA could be seen in both groups without significant group difference (KL pre-operative: 2.3, SD 0.63; KL FU: 2.8, SD 0.74; p < 0.001). The radiographic leg alignment at FU showed a significant lower valgus alignment in group 1 (group 1: 0.4 degree, SD 3.3 degree; group 2: 2.1 degree, SD 2.1 degree; p = 0.039). The rate of post-operative complications was low with 4%, and no significant group differences were found.
  
  
  CONCLUSIONS
  This study shows that HTO alone can improve pain and even subjective knee stability. Additional ACLR was in the mid term not associated with a higher increase of OA or a higher rate of post-operative complications in our study collective.
authors.affiliation: Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Hugstetter Str. 55, 79095, Freiburg, Germany. julianmehl@gmx.de.
authors.forename: Julian
authors.initials: J
authors.lastname: Mehl
authors.affiliation: Praxisklinik Rennbahn AG, Basel, Switzerland.
authors.forename: Jochen
authors.initials: J
authors.lastname: Paul
authors.affiliation: Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Hugstetter Str. 55, 79095, Freiburg, Germany.
authors.forename: Matthias J
authors.initials: MJ
authors.lastname: Feucht
authors.affiliation: Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Hugstetter Str. 55, 79095, Freiburg, Germany.
authors.forename: Gerrit
authors.initials: G
authors.lastname: Bode
authors.affiliation: Department of Orthopedic Sports Medicine, Klinikum Rechts der Isar, Technische Universität Muenchen, Munich, Germany.
authors.forename: Andreas B
authors.initials: AB
authors.lastname: Imhoff
authors.affiliation: Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Hugstetter Str. 55, 79095, Freiburg, Germany.
authors.forename: Norbert P
authors.initials: NP
authors.lastname: Südkamp
authors.affiliation: OrthoPlus, Munich, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Hinterwimmer
mesh_terms: D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D007718:Knee Injuries / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D020370:Osteoarthritis, Knee / Q000150:complications / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D011859:Radiography; D016059:Range of Motion, Articular; D016896:Treatment Outcome
keywords: ACL reconstruction; Anterior instability; HTO; Knee; Osteoarthritis; Varus