Simultaneous Arthroscopic Anterior Cruciate Ligament Reconstruction and Medial Opening Wedge High Tibial Osteotomy Using Locked Plate and Synthetic Bone Graft (TUTOBONE®)

Abstract

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.