Radiographic and clinical outcomes of slope and varus correction anterior closing wedge tibial osteotomy for primary anterior cruciate ligament injuries with steep posterior tibial slope, varus knee deformity, and medial meniscal posterior root tears

Abstract

Background: previous biomechanical studies have investigated the influence of coronal and sagittal correction high tibial osteotomy in ACL-reconstructed knees. However, no studies have reported its clinical application. Our objective was to evaluate the radiological and clinical results after simultaneous slope and varus correction anterior closing wedge tibial osteotomy (ACWTO) and anterior cruciate ligament (ACL) reconstruction in patients with ACL deficiency combined with steep posterior tibial slope (PTS), varus deformity, and medial meniscal posterior root tear (MMPRT).Methods: Between January 2018 and December 2021, 5 patients with ACL injuries who had steep PTS, varus deformity, and concomitant MMPRT underwent slope and varus correction ACWTO combined with primary ACLR. The mean follow-up duration was 26.2 months. Preoperative and postoperative radiological assessments included the degree of the femoral tibial angle (FTA), PTS, progression of medial osteoarthritis . For clinical outcomes, we evaluated KT-1000 side-to-side difference, pivot-shift test, International Knee Documentation Committee (IKDC) score, Lysholm score and Tegner activity score preoperatively and at the last follow-up.Results: The mean PTS was 17.0° (range, 16°-19°) preoperatively and 7.8° (range, 6°-9°) postoperatively (P ＜0.01). The mean FTA was 5.6° (range, 5°-7°) preoperatively and -0.6°(range, -2°-0°) postoperatively (P ＜ 0.01). According to the Kellgren-Lawrence classification, 4 patients was grade 1, and 1 patient was grade 2 at the last follow-up. All patients showed statistically significant improvements in knee stability (pre- vs postoperatively：mean side-to-side difference, 9.2 mm vs 0.6mm; and pivot-shift test, 2 grade I and 3 grade II vs 5 grade 0). All patients showed statistically significant improvements in function (pre- vs postoperatively: mean IKDC score, 48.8 vs 89.4; mean Lysholm score, 48.2 vs 93.0; and Tegner activity score, 4.0 vs 6.8). Moreover, no graft rerupture were found at the last follow-up.Conclusion: Slope and varus correction ACWTO combined with primary ACLR is a safe and effective procedure to improve knee stability and function in patients with ACL tear, steep PTS, varus knee deformity, and MMPRT.