Combined ACL reconstruction and opening wedge high tibial osteotomy at 10-year follow-up: excellent laxity control but uncertain return to high level sport

Abstract

Purpose The purpose of this study was to report the long-term outcomes of a continuous series of patients who underwent simultaneous anterior cruciate ligament (ACL) reconstruction and opening wedge high tibial osteotomy (HTO) for varus-related early medial tibio-femoral osteoarthritis. It was hypothesized that this combined surgery sustainably allowed return to sport with efficient clinical and radiological results. Methods From 1995 to 2015, all combined ACL reconstruction (bone-patellar tendon-bone graft) and opening wedge HTO for anterior laxity and early medial arthritis were included. Clinical evaluation at final follow-up used Tegner activity score, Lysholm score, subjective and objective IKDC scores. Radiologic evaluation consisted in full-length, standing, hip-to-ankle X-rays, monopodal weight-bearing X-rays and skyline views. AP laxity assessment used Telos™ at 150\xa0N load. Student’s t test was performed for matched parametric data, Wilcoxon for nonparametric variables and Friedman test was used to compare small cohorts, with p \u2009<\u20090.05. Results 35 Patients (36 knees) were reviewed with a mean follow-up of 10\u2009±\u20095.2\xa0years. The mean age at surgery was 39\u2009±\u20099. At final follow-up 28 patients (80%) returned to sport (IKDC\u2009≥\u2009B): 11 patients (31%) returned to sport at the same level and 6 (17%) to competitive sports. Mean subjective IKDC and Lysholm scores were 71.8\u2009±\u200914.9 and 82\u2009±\u200914.1, respectively. The mean decrease of the Tegner activity level from preinjury state to follow-up was 0.8 ( p\u2009 <\u20090.01). Mean side-to-side difference in anterior tibial translation was 5.1\u2009±\u20093.8\xa0mm. Three patients were considered as failures. The mean preoperative mechanical axis was 4.2°\u2009±\u20092.6° varus and 0.8°\u2009±\u20092.7° valgus at follow-up. Osteoarthritis progression for medial, lateral, and femoro-patellar compartments was recorded for 12 (33%, p\u2009 <\u20090.05), 6 (17%, p\u2009 <\u20090.001), and 8 (22%, p\u2009 <\u20090.05) knees, respectively. No femoro-tibial osteoarthritis progression was observed in 22 knees (61%). Conclusions Combined ACL reconstruction and opening wedge HTO allowed sustainable stabilization of the knee at 10-year follow-up. However, return to sport at the same level was possible just for one-third of patients, with femoro-tibial osteoarthritis progression in 39% of cases. Level of evidence III.