J Korean Orthop Assoc.  2009 Oct;44(5):548-555. 10.4055/jkoa.2009.44.5.548.

One-Staged Open-Wedge High Tibial Osteotomy and Anterior Cruciate Ligament Reconstruction

• Song EK
• Seon JK
• Park SJ
• Jeong MS

• KMID: 2186315
• DOI: http://doi.org/10.4055/jkoa.2009.44.5.548

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.

Keyword

Varus Knee; ACL insufficiency; Open-wedge High tibial osteotomy; ACL reconstruction; One-staged

MeSH Terms

Anterior Cruciate Ligament
Anterior Cruciate Ligament Reconstruction
Axis, Cervical Vertebra
Exercise Test
Humans
Joints
Knee
Lower Extremity
Osteoarthritis
Osteotomy
Physical Examination
Postoperative Complications
Prospective Studies
Rupture

Figure

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  Fig. 1 This photograph shows the Aescula® open-wedge plate system; plate and screw.

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  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.

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  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.

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  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.

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