Summary

Assessment of clinical and radiological results after simultaneous medial high tibial osteotomy with ACL reconstruction

Abstract

Introduction:Combining high tibial osteotomy with anterior cruciate ligament (ACL) reconstruction is a good option for treating young active patients suffering from varus knee deformity with associated ACL insufficiency. The presence of an increased tibial slope may cause ACL reconstruction failure and should corrected prior to the ACL reconstruction. The chronic insufficiency of ACL may cause high risk of posteromedial tibial plateau cartilage wear increasing the varus deformity. This can progress to slacking of the posteromedial ligamentous structures causing varus thrust (double varus) or triple varus with the occurance of recurvatum.
Patients and methods:A prospective clinical study carried between April 2014 and January 2018 including 45 male patients suffering from chronic ACL insufficiency with isolated varus knee deformity (Albäck 1-3) with an average age 24.6+/- 4.5 years. The exclusion criteria were skeletally immature patients, those with other ligamentous injuries requiring reconstruction, medial compartment osteoarthritis (Albäck 4and 5) and meniscal injuries requiring repair. All the patients had undergone arthroscopic ACL reconstruction using autologous semitendinosus and gracilis quadriple graft with simultaneous medial high tibial opening wedge osteotomy (MHTOWO) fixed with Puddu plates placed posteriorly to correct tibial slope and give room anteriorly for tibial ACL tunnel drilling with autologous iliac crest grafting. The patients were evaluated clinically using international knee documentation committee (IKDC) , Lysholm knee score and KT-1000 arthrometer. The radiological evaluation includes the standing hip knee ankle (HKA) angle and posterior tibial slope angle both preoperatively and postoperatively.

Results

The mean follow up was 36+/-5.26months . The mean subjective IKDC score improved from 42.9+/-1.2 preoperatively to 80.3+2.4 postoperatively which is statistically significant . 38 patients ( 84.4%) were graded A and B . The Lysholm score increased from (57.3+/-6.1 to 92.0+/-3.9) which is statistically significant. The KT-1000 arthrometer decreased from 6.4+/-2.2 mm to 2.9+/-1.3 . The mean HKA angle was 173.4°+/-2.5° and became 181.4°+/-1.7°. The posterior tibial slope was 8.7°+/-1.8°and became10.5°+2.4° . One caseof delayed union however no cases of fixation failure , recurrence of deformity or ACL failure.
Conclusion:The simultaneous ACL reconstruction with high tibial corrective osteotomy provided better outcomes regarding correction of the varus deformity, restoring knee stability with minimal complications.