Document Title: Noyes-AJSM-May00

Article Title: High tibial osteotomy and ligament reconstruction for varus-angulated anterior-cruciate-ligament-deficient knees

Authors: Frank R. Noyes, Sue D. Barber-Westin, Timothy E Hewett.

Publication: The American Journal of Sports Medicine

ISSN: 03635465

Date: May-June 2000.

(Figures included. Reference-denoting numbers appear in the same point size as document text.)

Volume: 28

Issue: 2

Pages: 282-296

Key Words: Knee, bow-leggedness, varus angulation, ACL reconstruction, bone, tibial osteotomy.

 

This articles describes the staged approach (i.e. high tibial osteotomy, with subsequent ACL reconstruction) in dealing with ACL-deficient patients who also happen to be bow-legged. The impact of bow-leggedness on knee biomechanics is profound; this must be kept in mind when a bow-legged person is pursuing ACL reconstruction.

 

ABSTRACT

 

In a consecutive series, we treated 41 young patients who had anterior cruciate ligament deficiency, lower limb varus angulation, and varying amounts of posterolateral ligament deficiency. Seventy-three percent of the patients (N = 30) had lost the medial meniscus and 63% (N = 26) had marked articular cartilage damage in the medial compartment. All patients were treated with high tibial osteotomy and, in the majority (N = 34), anterior cruciate ligament reconstruction a mean of 8 months later. Posterolateral reconstructions were also required in 18 knees. A 100% follow-up was obtained at a mean of 4.5 years after osteotomy. Gait analysis testing was done in 17 knees before and after osteotomy. At follow-up, a reduction in pain was found in 71 (29 knees); elimination of giving way, in 85% (35 knees); and resumption of light recreational activities without symptoms, in 66% (27 knees). The patient rating of the knee condition was normal or very good in 37% (15 knees) and good in 34% (14 knees). The mean Cincinnati Knee Rating Score significantly improved from 63 to 82 points. The mean adduction moment, 35% higher than controls preoperatively, significantly decreased to below normal values postoperatively. Correction of varus alignment was maintained in 33 knees (80%. We recommend osteotomy in addition to ligament reconstructive procedures in these knees with complex injury patterns.

 

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