High Tibial Osteotomy and Ligament Reconstruction for Varus Angulated Anterior Cruciate Ligament-Deficient Knees

• Published in: The American journal of sports medicine 2000-05, Vol.28 (3), p.282-296
• Main Authors: Noyes, F R, Barber-Westin, S D, Hewett, T E
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Algorithms; Anatomy & physiology; Anterior Cruciate Ligament - physiopathology; Anterior Cruciate Ligament - surgery; Bones; Cartilage, Articular - transplantation; Case-Control Studies; Chi-Square Distribution; Female; Gait - physiology; Health aspects; Humans; Internal Fixators; Joint Instability - physiopathology; Joint Instability - surgery; Knee; Knee Injuries - physiopathology; Knee Injuries - surgery; Knee Joint - physiopathology; Knee Joint - surgery; Ligaments; Ligaments, Articular - physiopathology; Ligaments, Articular - surgery; Male; Middle Aged; Osteotomy; Osteotomy - methods; Prospective Studies; Sports medicine; Surgery; Tibia; Tibia - surgery; Treatment Outcome
• ISSN: 0363-5465; 1552-3365
• DOI: 10.1177/03635465000280030201

In a consecutive series, we treated 41 young patients who had anterior cruciate ligament deficiency, lower limb varus angulation, and varying amounts of posterolateral ligament deficiency. Seventy-three percent of the patients ( N = 30) had lost the medial meniscus and 63% ( N = 26) had marked articular cartilage damage in the medial compartment. All patients were treated with high tibial osteotomy and, in the majority ( N = 34), anterior cruciate ligament reconstruction a mean of 8 months later. Posterolateral reconstructions were also required in 18 knees. A 100% follow-up was obtained at a mean of 4.5 years after osteotomy. Gait analysis testing was done in 17 knees before and after osteotomy. At follow-up, a reduction in pain was found in 71% (29 knees); elimination of giving way, in 85% (35 knees); and resumption of light recreational activities without symptoms, in 66% (27 knees). The patient rating of the knee condition was normal or very good in 37% (15 knees) and good in 34% (14 knees). The mean Cincinnati Knee Rating Score significantly improved from 63 to 82 points. The mean adduction moment, 35% higher than controls preoperatively, significantly decreased to below normal values postoperatively. Correction of varus alignment was maintained in 33 knees (80%). We recommend osteotomy in addition to ligament reconstructive procedures in these knees with complex injury patterns.