Published online Sep 23, 2009.
https://doi.org/10.4055/jkoa.2009.44.5.548
One-Staged Open-Wedge High Tibial Osteotomy and Anterior Cruciate Ligament Reconstruction
Abstract
Purpose
We wanted to evaluate the clinical and radiological results of one-staged open-wedge high tibial osteotomy (HTO) and arthroscopic anterior cruciate ligament (ACL) reconstruction for patients with complete rupture of the ACL and concomitant varus malalignment of the lower limb.
Materials and Methods
Twenty-five patients were prospectively assessed before and 1 year after their simultaneous operation as a single procedure. The clinical assessment included the Lysholm score, the Tegner activity level scale and a physical examination. The radiological data was used to calculate the mechanical axis, the joint space, the tibial slope and the arthrometric stress test. The postoperative complications were also assessed.
Results
The Lysholm knee score and the Tegner activity level scale improved from a mean of 72.1 to 93.8 and from 1.45 to 4.65, respectively (p<0.05). According to the Lachmann test and the pivot shift test for stability, improvements were made to a grade of 0 or I in most of the patients (p<0.05) and the STSD with using an arthrometric device significantly improved from 8.8 mm to postoperative 2.6 mm (p<0.05). The mechanical axis significantly improved from varus 6.1 degrees to valgus 0.3 degrees (p<0.05). Osteoarthritis of the knee, the posterior tibial slope and the joint space did not show any significant changes (p>0.05). The severity and rate of the postoperative complications were both low.
Conclusion
One-staged open-wedge HTO and ACL reconstruction produced satisfactory correction of the mechanical axis alignment and, it improved knee function. Further, the procedure had a low complication rate. It is also cost effective due to, reducing the frequency of operation and avoiding overlap of rehabilitation.
Fig. 1
This photograph shows the Aescula® open-wedge plate system; plate and screw.
Fig. 2
This radiographs show the preoperative antero-posterior and lateral radiography (A), the teleoroentgenography (B) and the STSD with using Telos® device (C); the posterior slope was 8.5°, the mechanical axis deviation was varus 7°, and the STSD was 7 mm at 20 Lbs.
Fig. 3
This intra-operative photograph shows the ACL graft after fixation in tibial tunnel with bio-interference screw with additional staple after open-wedge HTO.
Fig. 4
This radiographs show the postoperative antero-posterior and lateral radiography (A), and the teleoroentgenography (B) and the STSD after 1 year post-operation (C); the posterior slope was 9°, the mechanical axis deviation was varus 0°, and the STSD was 3 mm at 20 Lbs. (A): lateral cortex without breakage is preserved and height of anterior plate is 70% compared to posterior plate to prevent increase of the posterior slope. In addition, well placed Endo-button is shown.
Table 1
Charateristics of Patient Enrolled in the Current Study
Table 2
Stability Test Evaluated by Lachmann and Pivot Shift Test
Table 3
Radiological Results Evaluated by Mechanical Axis Deviation, Medial and Lateral Joint Space and Posterior Slope
Table 4
Comparative Study of Complication Rate
References
-
Holden DL, James SL, Larson RL, Slocum DB. Proximal tibial osteotomy in patients who are fifty years old or less. A long-term follow-up study. J Bone Joint Surg Am 1988;70:977–982.
-
-
Dejour H, Neyret P, Boileau P, Donell ST. Anterior cruciate reconstruction combined with valgus tibial osteotomy. Clin Orthop Relat Res 1994;299:220–228.
-
-
Noyes FR, Barber-Westin SD, Hewett TE. High tibial osteotomy and ligament reconstruction for varus angulated anterior cruciate ligament-deficient knees. Am J Sports Med 2000;28:282–296.
-
-
Song EK, Seon JK, Park SJ. How to avoid unintended increase of posterior slope in navigation assisted open-wedge high tibial osteotomy. Orthopedics 2007;30 Suppl:127–131.
-
-
Fried JA, Bergfield JA, Weiker G, Andrish JT. Anterior cruciate reconstruction using the Jones-Ellison procedure. J Bone Joint Surg Am 1985;67:1029–1033.
-
-
Bartlett RJ, Crowe R. Results of intra-articular anterior cruciate ligament reconstruction using patellar ligament. J Bone Joint Surg Br 1984;66:788.
-
-
Agneskirchner JD, Hurschler C, Stukenborg-Colsman C, Imhoff AB, Lobenhoffer P. Effect of high tibial flexion osteotomy on cartilage pressure and joint kinematics: a biomechanical study in human cadaveric knees. Winner of the AGA-Donjoy Award 2004. Arch Orthop Trauma Surg 2004;124:575–584.
-