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

Eun-Kyoo Song; Jong-Keun Seon; Sang-Jin Park; Mun-Su Jeong

doi:10.4055/jkoa.2009.44.5.548

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Song, Seon, Park, and Jeong: One-Staged Open-Wedge High Tibial Osteotomy and Anterior Cruciate Ligament Reconstruction

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2009; 44(5): 548-555.

Published online: 23 September 2009

DOI: https://doi.org/10.4055/jkoa.2009.44.5.548

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

Eun-Kyoo Song, M.D., Ph.D., Jong-Keun Seon, M.D., Sang-Jin Park, M.D., Mun-Su Jeong, M.D.

Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, Jeonnam, Korea.

Correspondence to Mun-Su Jeong, M.D. Center for Joint Disease, Chonnam National University Hwasun Hospital, 160 Ilsimri, Hwasun-eup, Hwasun-gun, Jeonnam 519-809, Korea. Tel: +82.61-379-7676, Fax: +82.61-379-7681, taesado@naver.com

Received 13 May 2009 Accepted 2 July 2009

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.

Keywords: Varus Knee, ACL insufficiency, Open-wedge High tibial osteotomy, ACL reconstruction, One-staged

Figures and Tables

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

^*Sx, symptom; ^†F/U, follow up; ^‡Medial comp OA, medial compartment osteoarthritis, Kellgren Lawrence classification on simple x-ray; ^§M-A, mechanical axis.

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

^*, indicate p<0.05 (Wilcoxon signed rank test); (-), indicate valgus angle.

Table 4

Comparative Study of Complication Rate

^*, One-staged operation is closed-wedge HTO and ACL reconstruction; ^†, Firstly, closed-wedge HTO is done, and ACL reconstruction is followed after 9 months; ^‡, One-staged operation is open-wedge HTO and ACL reconstruction; ^§, Complication.

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