Combined ACL reconstruction and opening wedge high tibial osteotomy at 10-year follow-up: excellent laxity control but uncertain return to high level sport

Abstract

Purpose The purpose of this study was to report the long-term outcomes of a continuous series of patients who underwent simultaneous anterior cruciate ligament (ACL) reconstruction and opening wedge high tibial osteotomy (HTO) for varusrelated early medial tibio-femoral osteoarthritis. It was hypothesized that this combined surgery sustainably allowed return to sport with efficient clinical and radiological results. Methods From 1995 to 2015, all combined ACL reconstruction (bone-patellar tendon-bone graft) and opening wedge HTO for anterior laxity and early medial arthritis were included. Clinical evaluation at final follow-up used Tegner activity score, Lysholm score, subjective and objective IKDC scores. Radiologic evaluation consisted in full-length, standing, hip-to-ankle X-rays, monopodal weight-bearing X-rays and skyline views. AP laxity assessment used Telos™ at 150 N load. Student's t test was performed for matched parametric data, Wilcoxon for nonparametric variables and Friedman test was used to compare small cohorts, with p < 0.05. Results 35 Patients (36 knees) were reviewed with a mean follow-up of 10 ± 5.2 years. The mean age at surgery was 39 ± 9. At final follow-up 28 patients (80%) returned to sport (IKDC ≥ B): 11 patients (31%) returned to sport at the same level and 6 (17%) to competitive sports. Mean subjective IKDC and Lysholm scores were 71.8 ± 14.9 and 82 ± 14.1, respectively. The mean decrease of the Tegner activity level from preinjury state to follow-up was 0.8 (p < 0.01). Mean side-to-side difference in anterior tibial translation was 5.1 ± 3.8 mm. Three patients were considered as failures. The mean preoperative mechanical axis was 4.2° ± 2.6° varus and 0.8° ± 2.7° valgus at follow-up. Osteoarthritis progression for medial, lateral, and femoropatellar compartments was recorded for 12 (33%, p < 0.05), 6 (17%, p < 0.001), and 8 (22%, p < 0.05) knees, respectively. No femoro-tibial osteoarthritis progression was observed in 22 knees (61%). Conclusions Combined ACL reconstruction and opening wedge HTO allowed sustainable stabilization of the knee at 10-year follow-up. However, return to sport at the same level was possible just for one-third of patients, with femoro-tibial osteoarthritis progression in 39% of cases. Level of evidence III.

ACL Reconstruction and High Tibial Valgus Osteotomy for Management of ACL Deficient Varus knee

“…in Schneider et al, 2020, comparative radiologic lachman (mm) was 9.9 ± 5.1 then 5.1 ± 3.8 postoperatively (p<0.05). Single-leg stance (mm) was 6.3 ± 3.8 then 3.4 ± 4.7 (p<0.05) [12,13].…”

“…Also, Posterior tibial slope was reported in five studies with significant postoperative change. Mechanical axis was found to be significantly changed after combined intervention [12][13][14][15][16].…”

“…Late entanglements included two instances of arthrofibrosis requiring arthroscopic arthrolysis in the two cases and resection of a cyclops sore in one. Thirteen patients (37%) went through expulsion of unmistakable obsession hardware [12,17].…”

“…Concerning the action level after secluded HTO ,indicated that 87-94% of patients could get back to don, and 85% got back to their pre-suggestive games level after knee osteotomies .Bonnin et al in a multicenter review study demonstrated that youthful propelled patients had the option to continue arduous exercises following HTO yet must be educated that they would commonly not recuperate their pre-pathology level and that remaining torment during demanding games was not exceptional [12].…”

“…Notwithstanding, the 5.1 mm differential found in this arrangement was marginally higher than that found in the writing. This is perhaps clarified by a bigger number of average meniscectomies, and various past surgeries [12].…”