[Combination of ACL-replacement and high tibial osteotomy]

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Biomechanical Engineering

Background:

• Simultaneous symptomatic anterior cruciate ligament (ACL) insufficiency and varus osteoarthritis present a complex treatment challenge.
• Traditional approaches may involve staged procedures, potentially increasing overall treatment time and patient burden.
• A combined one-stage surgery offers a potential solution for concurrent correction of ligamentous instability and joint alignment.

Purpose of the Study:

• To describe and evaluate a single-stage surgical technique for simultaneous ACL reconstruction using autologous tendon graft and high tibial osteotomy (HTO).
• To address the indications, contraindications, surgical technique, and postoperative management for this combined procedure.

Main Methods:

• The surgical technique involves precise osteotomy of the tibia to correct varus alignment, followed by arthroscopic ACL reconstruction using a standard autograft.
• Osteotomy fixation is achieved with an angle-stable plate, and ACL graft fixation utilizes a button-wire construct and interference screws.
• Careful planning is essential to avoid interference between the tibial tunnel and osteotomy fixation hardware.

Main Results:

• The described technique allows for simultaneous correction of ACL insufficiency and varus osteoarthritis in a single operative session.
• Specific considerations for patient selection, including exclusion criteria like posterolateral instability, are crucial for successful outcomes.
• Postoperative rehabilitation protocols are tailored, with weight-bearing aligned to osteotomy guidelines and range of motion following ACL protocols.

Conclusions:

• This one-stage surgical approach provides a viable option for managing combined ACL deficiency and varus knee osteoarthritis.
• Careful patient selection and meticulous surgical technique are paramount to minimize potential complications associated with combined procedures.
• The described method integrates biomechanical correction with ligamentous reconstruction for comprehensive knee joint restoration.