Five-Year Changes in Gait Biomechanics After Concomitant High Tibial Osteotomy and ACL Reconstruction in Patients With Medial Knee Osteoarthritis

Marriott, Kendal; Birmingham, Trevor B.; Kean, Crystal O.; Hui, Catherine; Jenkyn, Thomas R.; Giffin, J. Robert

doi:10.1177/0363546515591995

Cited by 51 publications

(36 citation statements)

References 53 publications

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“…Our findings suggest that individuals with concomitant varus malalignment and ACL deficiency, who undergo medial opening‐wedge HTO, will experience a favorable shift in load distribution and a potential reduction in the progression of medial knee OA, regardless of ACL reconstruction. For the HTO group, changes in the frontal and sagittal plane gait biomechanics were comparable to the long‐term (>5 years) changes observed following combined HTO and ACL reconstruction in a similar group of individuals …”

Section: Discussionsupporting

confidence: 57%

“…Knee OA and ACL gait studies typically focus on changes in the frontal and sagittal planes, respectively. However, transverse plane knee angles and moments have also been reported in these patient populations . Although not included in our a priori hypotheses, there were no statistically significant changes over time or differences between groups for the transverse plane data assessed in the present study.…”

Section: Discussionmentioning

confidence: 57%

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Gait biomechanics after combined HTO‐ACL reconstruction versus HTO alone: A matched cohort study

Marriott

Birmingham

Pinto

et al. 2018

Journal Orthopaedic Research

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The purpose of the present study was to compare bilateral external knee moments during gait in patients with concomitant medial compartment knee OA, varus alignment and chronic anterior cruciate ligament (ACL) deficiency who underwent either medial opening‐wedge high tibial osteotomy alone (HTO) or simultaneous HTO and ACL reconstruction (HTO‐ACLR). Fifty‐two patients (26 matched pairs) completed 3D gait analysis preoperatively and at a minimum 5 years postoperatively. Patients were matched for preoperative age, sex, body mass index and magnitude of correction. Primary outcomes selected a priori were the peak knee adduction moment (KAM) and knee flexion (KFM) moment during stance. Moments were compared using mixed model repeated measures analysis of variance (ANOVA). For the peak KAM, there was a significant time by limb interaction. For both groups, there were similar reductions in the peak KAM 5 years postoperatively in the surgical limb only [−1.34 %BW × Ht (−1.71, −0.96) and −1.72 %BW × Ht (−1.99, −1.44) for HTO and HTO‐ACLR, respectively]. For the peak KFM, there was a significant time by group by limb interaction. There was a decrease in the peak KFM 5 years postoperatively in the HTO group [−0.88 %BW × Ht (−1.45, −0.31)] but not in the HTO‐ACLR group [0.03 %BW × Ht (−0.43, 0.48)]. These results suggest that individuals with medial knee OA, varus alignment and chronic ACL deficiency who undergo simultaneous medial opening‐wedge HTO and ACL reconstruction may not experience the same long‐term (5 year) changes in sagittal plane knee biomechanics observed in patients undergoing HTO alone. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res

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Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 57%

Gait biomechanics after combined HTO‐ACL reconstruction versus HTO alone: A matched cohort study

Marriott

Birmingham

Pinto

et al. 2018

Journal Orthopaedic Research

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“…Based on gait analysis, HTO combined with ACLR significantly decreased peak knee adduction moment and knee internal rotation moment, and these changes correlated with the decrease in static varus alignment. 27,36 …”

Section: Resultsmentioning

confidence: 99%

The Impact of Osseous Malalignment and Realignment Procedures in Knee Ligament Surgery: A Systematic Review of the Clinical Evidence

Tischer

Paul²,

Pape

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Failure rates of knee ligament surgery may be high, and the impact of osseous alignment on surgical outcome remains controversial. Basic science studies have demonstrated that osseous malalignment can negatively affect ligament strain and that realignment procedures may improve knee joint stability.Hypothesis/Purpose:The purpose of this review was to summarize the clinical evidence concerning the impact of osseous malalignment and realignment procedures in knee ligament surgery. The hypotheses were that lower extremity malalignment would be an important contributor to knee ligament surgery failure and that realignment surgery would contribute to increased knee stability and improved outcome in select cases.Study Design:Systematic review; Level of evidence, 4.Methods:According to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic electronic search of the PubMed database was performed in November 2015 to identify clinical studies investigating (A) the influence of osseous alignment on postoperative stability and/or failure rates after knee ligament surgery and (B) the impact of osseous realignment procedures in unstable knees with or without additional knee ligament surgery on postoperative knee function and stability. Methodological quality of the studies was assessed using the Oxford Centre for Evidence-Based Medicine Levels of Evidence and the Coleman Methodological Score (CMS).Results:Of the 1466 potentially relevant articles, 28 studies fulfilled the inclusion and exclusion criteria. Average study quality was poor (CMS, 40). For part A, studies showed increased rerupture rate after anterior cruciate ligament (ACL) replacement in patients with increased tibial slope. Concerning the posterior cruciate ligament (PCL)/posterolateral corner (PLC)/lateral collateral ligament (LCL), varus malalignment was considered a significant risk factor for failure. For part B, studies showed decreased anterior tibial translation after slope-decreasing high tibial osteotomy in ACL-deficient knees. Correcting varus malalignment in PCL/PLC/LCL instability also showed increased stability and better outcomes.Conclusion:In cases of complex knee instability, the 3-dimensional osseous alignment of the knee should be considered (eg, mechanical weightbearing line and tibial slope). In cases of failed ACL reconstruction, the tibial slope should be considered, and slope-reducing osteotomies are often helpful in the patient revised multiple times. In cases of chronic PCL and/or PLC instability, osseous correction of the varus alignment may reduce the failure rate and is often the first step in treatment. Changes in the mechanical axis should be considered in all cases of instability accompanied by early unicompartmental osteoarthritis.

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“…Osteotomy or realignment surgery can be used in this setting to treat both pain and instability by altering the posterior tibial slope, thereby changing the sagittal plane alignment [8, 9] in addition to the coronal alignment. This can be performed in conjunction with a ligament reconstruction in either a simultaneous or staged fashion [10–16]. …”

Section: Introductionmentioning

confidence: 99%

High tibial osteotomy in the ACL-deficient knee with medial compartment osteoarthritis

Herman

Giffin

2016

J Orthopaed Traumatol

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High tibial osteotomy (HTO) has traditionally been used to treat varus gonarthrosis in younger, active patients. Varus malalignment 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. Detailed history, physical exam and radiographic analysis guide treatment decisions in this high demand patient population. Lateral closing wedge (LCW) and medial opening wedge (MOW) HTOs have been performed and their potential advantages and disadvantages have been well described. Given the triangular shape of the proximal tibia, it is imperative that the surgeon pay close attention to the geometry of the osteotomy “gap” when performing MOW HTO to avoid inadvertently increasing the posterior tibial slope. Simultaneous ACL reconstruction may require technique modifications depending on the type of HTO and ACL graft chosen. With appropriate patient selection and good surgical technique, it is reasonable to expect patients to return to activities of daily living and recreational sports without debilitating pain or instability.

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Five-Year Changes in Gait Biomechanics After Concomitant High Tibial Osteotomy and ACL Reconstruction in Patients With Medial Knee Osteoarthritis

Abstract: These findings suggest that concomitant HTO and ACL reconstruction results in substantial changes in gait biomechanics. Future clinical research comparing treatment strategies is both warranted and required for this relatively uncommon but seemingly biomechanically efficacious procedure.

Cited by 51 publications

References 53 publications

Gait biomechanics after combined HTO‐ACL reconstruction versus HTO alone: A matched cohort study

Gait biomechanics after combined HTO‐ACL reconstruction versus HTO alone: A matched cohort study

The Impact of Osseous Malalignment and Realignment Procedures in Knee Ligament Surgery: A Systematic Review of the Clinical Evidence

High tibial osteotomy in the ACL-deficient knee with medial compartment osteoarthritis

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