ISAKOS: 2019 Congress in Cancun, Mexico
ISAKOS

2019 ISAKOS Biennial Congress ePoster #1229

 

Outcomes of Simultaneous Open Wedge High Tibial Osteotomy and Anterior Cruciate Ligament Reconstruction in Anterior Cruciate Ligament Deficiency with Medial Unicompartmental Osteoarthritis

Jong-Keun Seon, MD, PhD, Hwasun, Jeonnam KOREA, REPUBLIC OF
Eun-Kyoo Song, MD, PhD, Prof., Gwangju KOREA, REPUBLIC OF
Seung-Min Na, MD, Gwangju KOREA, REPUBLIC OF

Chonnam National University Hwasun Hospital, Hwasun, Jeonnam, KOREA, REPUBLIC OF

FDA Status Not Applicable

Summary

Simultaneous open wedge HTO and ACL reconstruction showed satisfactory correction angle and improved knee joint function without any serious complications.

Abstract

Introduction

Varus thrust of the knee is a dynamic increase of an often pre-existing varus angle and it is suspected to be a major reason for failure of anterior cruciate ligament (ACL) reconstruction. We performed open wedge high tibial osteotomy (HTO) and arthroscopic ACL reconstruction simultaneously on ACL deficient patients who had medial unicompartemtnal osteoarthritis (OA) and varus deformity. We aimed to evaluate clinical and radiological results after simultaneous open wedge HTO and arthroscopic ACL reconstruction in patients with ACL deficiency and medial unicompartemtnal OA with varus deformity.

Materials And Methods

From April 2004 to March 2010, total 35 patients who were diagnosed as ACL injury by physical exam and MRI and also had medial unicompartmental OA and varus deformity on standing plain radiograph, underwent open wedge HTO and arthroscopic ACL reconstruction, simultaneously. Minimum follow-up duration was 4 years and mean follow-up duration was 5.6years. Clinically, we evaluated preoperative and postoperative Lysholm score, Tegner activity score, physical examination (range of motion, Lachmann test, Pivot shift test, anterior drawer test) and radiologically evaluated amount of varus deformity, joint space narrowing, tibial posterior slope, medial instability, anterior translation and postoperative complications.

Results

In all cases, there were no limitations on range of motion, 6 patients showed progression of medial unicompartmental OA.The Lysholm score was improved from 72.1 to 93.8 points(p=0.04). Mechanical axis was significantly corrected from varus 6.1 degrees to valgus 0.3 degrees (p=0.01), and tibial posterior slope did not show significant differences(p=0.71). Joint spaces were changed from 3.55mm to 3.84mm in the medial side, and 5.75 to 5.60mm in the lateral side, but it did not show significant differences(p>0.05). Also, there were no medial instabilities. Lachman test and pivot shift test were significantly improved and side to side difference using Telos® arthrometer, was improved from 7.75mm to 2.6mm postoperatively (p=0.03). For the complication, hypersensitivity on tibial anterolateral area was 3cases and there was 1case of pain on the incision area. There were no nonunion or fixation loss cases.

Conclusions

Simultaneous open wedge HTO and ACL reconstruction showed satisfactory correction angle and improved knee joint function without any serious complications.