Arthritis and osteotomies in anterior cruciate ligament reconstruction

Unfortunately, young patients with active life-styles who present with an ACL-deficient knee and early evidence of arthritis remain a very difficult population to treat. Arthroscopic ACL reconstruction is a proven and effective way to treat patients with anterior knee instability [2]. In addition, numerous authors have demonstrated that knee osteotomies are effective in addressing isolated medial or lateral compartment degenerative disease, even in the presence of anterior knee instability [7, 9, 22, 43]. A comprehensive evaluation of pain, alignment, and stability are necessary in order to formulate the best treatment plan for each patient. Patients with combined chronic instability secondary to ACL insufficiency and unicompartmental arthritis will generally benefit from arthroscopic debridement, ACL reconstruction, knee osteotomy, or any combination thereof. Expectations of patients should be managed according to their underlying pathology, and this is a critical component for the success of the surgery. Most patients will get some degree of symptomatic relief and functional improvement. A return to competitive or high-level sports is an unrealistic goal, however, and should be discouraged.