Prospective study of the anterior cruciate ligament reconstruction associated with high tibial opening wedge osteotomy in knee arthritis associated with instability

Vaishya, Raju; Vijay, Vipul; Jha, Gyanendra Kumar; Agarwal, Amit Kumar

doi:10.1016/j.jcot.2016.06.010

Cited by 11 publications

(6 citation statements)

References 20 publications

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“…The bone staples are simple and inexpensive to use and provide some stability to the osteotomy. 21 (Fig. 3) However, the fixation given by the staples is not robust and sufficient enough to allow immediate movements of the knee and weight bearing on the operated leg.…”

Section: Reviewmentioning

confidence: 99%

A critical appraisal of medial open wedge high tibial osteotomy for knee osteoarthritis

Vaishya

Bijukchhe

Agarwal

et al. 2018

Journal of Clinical Orthopaedics and Trauma

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A medial open wedge high tibial osteotomy (MOWHTO) is an effective surgical procedure to correct varus deformity related to Knee Osteoarthritis. It consistently provides relief in knee pain and improves knee function. This technique is recommended for active, middle and old aged individuals with an isolated medial compartment knee OA. The MOWHTO scores several advantages over lateral closed wedge osteotomy and hence is now a preferred choice of HTO.

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Section: Reviewmentioning

confidence: 99%

A critical appraisal of medial open wedge high tibial osteotomy for knee osteoarthritis

Vaishya

Bijukchhe

Agarwal

et al. 2018

Journal of Clinical Orthopaedics and Trauma

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“…We present a novel technique of performing the MOWHTO without using any metallic implants. This technique can be performed in most cases with mild-to-moderate genu varum deformity (<10°), without any hardware by using a beta-tricalcium phosphate (TCP) wedge and achieving satisfactory alignment and functional results 8–10. This procedure avoids the likely problems associated with the use of metallic implants.…”

Section: Discussionmentioning

confidence: 99%

Bilateral genu varum deformity correction in an adult by medial opening-wedge high tibial osteotomy without internal fixation

et al. 2022

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A young adult man in 20s presented with bow leg deformity of both the knees, since childhood and bilateral knee pain for the last 4 years. Plain radiographs of both the knees confirmed bilateral genu varum deformity, more on the right side (16.2°) as compared with left (12.3°). He was managed surgically by a single-stage bilateral medial opening wedge high tibial osteotomy, using a synthetic bone substitute of a tri calcium phosphate. After the healing of osteotomies at 3 months, the patient was pain free and walked comfortably with normal lower limb alignment.

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“…This systematic review identified improved post‐operative functional outcomes following combined HTO and ACLR compared to pre‐operative scores. Studies reported significant post‐operative improvement in pain, function, and stability across a variety of scales [1, 3, 11, 21, 22, 29, 32, 34]. This is particularly important as patients’ post‐operative perception and satisfaction of their knee surgery is dependent upon function and return to activities of daily living, rather than clinical exam findings [12].…”

Section: Discussionmentioning

confidence: 99%

“…It has been suggested to combine ACLR and HTO to treat ACLD knees with varus angulation [2, 8, 25]. Researchers have demonstrated benefits from performing the combined procedure [18, 22, 32]. Despite potential benefits, some surgeons may be hesitant to perform this surgery for two reasons.…”

Section: Introductionmentioning

confidence: 99%

Indications and outcomes of simultaneous high tibial osteotomy and ACL reconstruction

Stride

Wang

Horner

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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Purpose The purpose of this study was to systematically review the existing literature reporting surgical outcomes of simultaneous high tibial osteotomy (HTO) and anterior cruciate ligament reconstruction (ACLR) in anterior cruciate ligament deficient (ACLD) knees. Methods This study was conducted per the methods of the Cochrane Handbook for Systematic Reviews of Intervention, with findings reported per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The electronic databases MEDLINE, EMBASE, and PubMed were searched for relevant studies and pertinent data was extracted. Studies reporting post-operative outcomes following simultaneous HTO and ACLR in ACLD knees were included. ResultsThe search identified 515 studies, of which 18 (n = 516) were included. The mean MINORS scores for non-comparative and comparative studies were 11.6 ± 1.34 and 17.3 ± 1.9, respectively. Simultaneous HTO and ACLR resulted in improved functional subjective patient outcomes across a variety of scales. Simultaneous HTO and ACLR was effective in correcting varus angulation, with the post-operative mechanical angle ranging from 0.3° valgus to 7.7° valgus. The reported complication rate ranged from 0 to 23.5%. Across six studies, a total of 13 (6.5%) patients required revision HTO; while across four studies, 20 (17.5%) patients had failure of the ACL graft, with one receiving revision ACLR. Conclusions Combined HTO and ACLR may be indicated in patients with ACLD knees with varus angulation. This systematic review found that the combined surgery resulted in significant improvement in post-operative functional subjective outcomes. However, it remains unclear if HTO with ACLR is superior to ALCR or HTO alone due to the lack of comparative studies. Overall, HTO with ACLR was found to have low rates of complications, re-ruptures, and need for revision surgery. This review found that patients continued to have progression of OA despite combined HTO with ACLR. Future research is required to better understand the effects of combined HTO and ACLR compared to ACLR or HTO alone and to evaluate the long-term post-operative progression of medial compartment OA following combined HTO and ACLR. Level of evidence IV.

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Prospective study of the anterior cruciate ligament reconstruction associated with high tibial opening wedge osteotomy in knee arthritis associated with instability

Cited by 11 publications

References 20 publications

A critical appraisal of medial open wedge high tibial osteotomy for knee osteoarthritis

A critical appraisal of medial open wedge high tibial osteotomy for knee osteoarthritis

Bilateral genu varum deformity correction in an adult by medial opening-wedge high tibial osteotomy without internal fixation

Indications and outcomes of simultaneous high tibial osteotomy and ACL reconstruction

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