Background: Nowadays combined high tibial osteotomy and ACL reconstruction is accepted as a safe and effective
surgery for patients with symptomatic varus osteoarthritis and anterior knee instability; however, the source of varus
deformity is sometimes the femoral bone. No studies have reported concomitant ACL reconstruction and distal femoral
osteotomy in ACL-deficient knees with femoral varus deformity and medial osteoarthritis till now. This prospective
study presents the technique and clinical outcome of a consecutive series of simultaneous lateral closed-wedge distal
femoral osteotomy and ACL reconstruction.
Methods: Nineteen patients with confirmed ACL rupture and femoral varus deformity (mechanical lateral distal femoral
angle ≥ 93°) associated with medial osteoarthritis (± lateral thrust) were included the study. The patients underwent
simultaneous lateral closed-wedge distal femoral osteotomy and ACL reconstruction. At the end of one year follow
up, the final range of motion and stability of the knees and the last alignment of extremities were recorded. Surgical
outcomes were assessed on 2000 IKDS subjective scores and KOOS subscales.
Results: The mean preoperative varus knee was 10.6° (±2.2°) mostly from the femoral side. The mean union time
was 3.2 (±0.4) months. Regarding the radiological evaluation, the alignment of extremity and mLDFA were corrected
significantly compared to the pre-operative findings. At the end of one year follow up, all patients were free of knee
instability. Subjective assessment based on questionnaires showed a significant improvement in all aspects of knee
function after surgery, however there was no considerable change in the knees range of motion.
Conclusion: Simultaneous lateral closed- wedge distal femoral osteotomy and ACL reconstruction is a valuable
procedure in femoral varus knees with medial osteoarthritis and anterior knee instability. After one year follow up all
aspects of knee function were improved without serious complications.
Level of evidence: IV