Simultaneous anterior cruciate ligament reconstruction and opening wedge high tibial osteotomy: Report of four cases

Combined Biplanar High Tibial Osteotomy, Anterior Cruciate Ligament Reconstruction, and Abrasion/Microfracture in Severe Medial Osteoarthritis of Unstable Varus Knees

“…Only limited data are available for combined procedures using modern implants, and no study has exclusively investigated combined approaches in severe medial osteoarthritis. 20 From our data, it might be assumed that the performed complex procedure can postpone joint replacement because this (mainly TKA) would have been the alternative surgical treatment for all patients included, although there is no control group of conservatively treated patients to prove this. Furthermore, if arthroplasty should be necessary within the further course because of persistent or reoccurring complaints from unicondylar osteoarthritis, a corrected axis and regained ligamentous stability might facilitate or enable the implantation of a UKA instead of a TKA in the first place in these cases, which would not have been possible in an ACL-insufficient knee with significant varus malalignment.…”

“…There is considerable heterogeneity in surgical technique (mainly closed-wedge osteotomies), implants (mainly non-angular stable fixation), and ACLR technique (mainly boneepatellar tendonebone autografts, nonanatomic femoral positioning, and concomitant extra-articular procedures). [20][21][22][23][24][25][26][27][28][29][30]32,33 Therefore comparison is limited. Furthermore, mainly patients with imminent or early osteoarthritis were included.…”

“…25,27,32 Suggestions range from isolated ACLR over isolated osteotomy (with and without slope modification) and combined approaches using 1-or 2-staged concepts to unicondylar arthroplasty with or without ACLR. 4,5,18,20,21,23,25,27,28,30,[32][33][34] Interestingly, Williams et al 32 found better results in patients with a combined procedure compared with isolated osteotomy at short-term follow-up. Given these encouraging results, this might be seen more as a standard procedure instead of a salvage procedure.…”

“…16 Numerous studies have investigated combined approaches of osteotomy and ACLR in early or imminent osteoarthritis as salvage procedures for young patients. [20][21][22][23][24][25][26][27][28][29][30][31][32][33] Only 1 of these studies (including 4 patients) has used the latest generation of implants (angular stable plate fixator). 20 So far, no study has investigated cases of severe osteoarthritis or combined chondral resurfacing (CR) or cartilage restoration procedures.…”

“…[20][21][22][23][24][25][26][27][28][29][30][31][32][33] Only 1 of these studies (including 4 patients) has used the latest generation of implants (angular stable plate fixator). 20 So far, no study has investigated cases of severe osteoarthritis or combined chondral resurfacing (CR) or cartilage restoration procedures. However, young patients with a high degree of unicompartmental osteoarthritis and chronic ACL insufficiency are especially difficult to treat because total knee arthroplasty (TKA) is not a desirable option, and an intact ACL is seen as a precondition for unicondylar knee arthroplasty (UKA).…”