Background: Chronic anterior cruciate ligament (ACL) deficiency is associated with knee instability and development of chronic varus malignment and medial compartment osteoarthritis (OA). ACL reconstruction (ACLR) is performed with high success rate in most patients. However, patients presenting with chronic anterior cruciate ligament deficient (ACLD) and varus angulated knees represent a challenge to orthopedic surgeons, as ACLR addresses anterior knee instability alone, however, it fails to correct knee malignment, and thus, fails to impact the progression of OA. Aim of Study:The aim of this study is to prospectively assess the effectiveness of management of varus angulated-ACL deficient knees by simultaneous arthroscopic ACL reconstruction and medial opening wedge high tibial osteotomy (HTO) using locked plate and synthetic bone graft. The Lysholm knee scoring systems are used to assess the patients. Clinical outcomes are assessed preoperatively and at 20 months post-operatively.Patients and Methods: This prospective study included 20 patients. The patients' age ranged between 18-40 years, all were males, most injuries were sports injury and all of them suffered from chronic ACL insufficiency with varus deformity. All patients underwent simultaneous arthroscopic ACL reconstruction and medial opening wedge high tibial osteotomy (HTO) using locked plate and synthetic bone graft.Clinical outcomes were assessed with the Lysholm knee scoring system, pivot shift test, anterior drawers test and Lachman test; and KT-1000 arthrometer. Preoperatively, MRI and X-ray were used for ACL diagnosis and for measuring degree of varus, the standing hip knee ankle angle (HKA °, alignment), posterior tibial slope (PTS), lateral joint opening and degree of arthritis. Postoperative X-rays were done to evaluate deformity correction, union, fixation devices and tunnels position. All patients were followed-up at 2 weeks and at 1, 3, 6, 12 and 20 months postoperatively. Clinical outcomes were assessed preoperatively and at 20 months postoperatively.
Background: High tibial osteotomy (HTO) has traditionally been used to treat varus gonarthrosis in younger, active patients. Varus malignment increases the risk of progression of medial compartment osteoarthritis and an HTO can be performed to realign the mechanical axis of the lower limb towards the lateral compartment, thereby decreasing contact pressures in the medial compartment. Anterior cruciate ligament (ACL) insufficiency may lead to post-traumatic arthritis due to altered joint loading and associated injuries to the menisci and articular cartilage. Understanding the importance of posterior tibial slope and its role in sagittal knee stability has led to the development of biplane osteotomies designed to flatten the posterior tibial slope in the ACL deficient knee. Altering the alignment in both the sagittal and coronal planes helps improve stability as well as alter the load in the medial compartment.Aim of Study: Was to prospectively assess the effectiveness of management of varus angulated-ACL deficient knees by simultaneous arthroscopic ACL reconstruction and medial opening wedge high tibial osteotomy (HTO) using locked plate and synthetic bone graft (TUTOBONE®). The IKDC scoring system is used to assess the patients. Clinical outcomes are assessed preoperatively and at 20 months post-operatively.
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