The Triple Varus Knee: A Case Presentation.

Area of Science:

• Orthopedic Surgery
• Knee Reconstruction
• Biomechanical Engineering

Background:

• Posterior cruciate ligament (PCL) and posterolateral corner (PLC) deficiency cause significant knee instability and reduced quality of life.
• Triple varus knee presents a complex challenge in orthopedic surgery.

Purpose of the Study:

• To present the surgical management of a triple varus knee with combined high tibial osteotomy (HTO) and revision PCL and PLC reconstruction.
• To detail the surgical technique for addressing combined PCL and PLC deficiency in varus malalignment.

Main Methods:

• The surgical technique involves a medial opening-wedge biplanar HTO fixed with a locking plate.
• Revision PCL and PLC reconstruction utilizes allograft (Achilles for PCL, semitendinosus for PLC) with specific tunnel drilling and fixation.
• Medial meniscus root repair is performed using sutures passed through a tibial tunnel and tied over a button.

Main Results:

• While specific outcomes for the combined procedure are not yet available, individual components have reported good to excellent results.
• The described technique addresses complex knee instability with a multi-faceted surgical approach.

Conclusions:

• Combined HTO and revision PCL and PLC reconstruction is a viable option for persistent instability in triple varus knees.
• This surgical approach should be considered for patients with failed prior reconstructions and varus malalignment.