Simultaneous High Tibial Osteotomy and Anterior Cruciate Ligament Reconstruction in knees with Bony Frontal and/or Sagittal Deformities: Review of the Current Literature

Document Type : In Brief

Authors

1 Department of Orthopedic Surgery, La Paz University Hospital, Madrid, Spain

2 Department of Orthopedic Surgery, Al Zahra Private Hospital Dubai, Dubai, UAE

Abstract

Simultaneous anterior cruciate ligament (ACL) reconstruction (ACLR) and valgus high tibial osteotomy (HTO) alleviates pain in 70% of individuals with ACL deficiency and varus femorotibial osteoarthritis, allows for sustainable stabilization of the knee at the 10-year follow-up and a return to sport (RTS) in 33%-80% of cases, but femorotibial osteoarthritis progression occurs in 39% of cases. The complication rate ranges from 0% to 23.5% (6.5% revision valgus HTO, 17.5% ACL graft failure, 7.7% venous thrombosis). Simultaneous ACLR and HTO leads to satisfactory results in patients with ACL deficiency and varus femorotibial osteoarthritis associated with a high posterior tibial slope (PTS) and appears to have a protective effect on further ruptures in the reconstructed ACL. The younger the patient and the more sporting demands he/she poses, the more we should be inclined to perform a combined intervention (ACLR and valgus HTO).
        Level of evidence: III

Keywords

Main Subjects

References

  1. Malahias M-A, Shahpari O, Kaseta M-K. The clinical outcome of one-stage high tibial osteotomy and anterior cruciate ligament reconstruction. A current concept systematic and comprehensive review. Arch Bone Jt Surg 2018;6(3):161-168.
  2. Moradi A, Sadeghpour A, Khalilpour A. The clinical outcome of simultaneous lateral closed- wedge distal femoral osteotomy and anterior cruciate ligament reconstruction in the ACL-deficient knees with symptomatic femoral varus deformity. Arch Bone Jt Surg 2020; 8(4):537-544. doi: 10.22038/abjs.2020.46686.2286.
  3. Shekhar A, Tapasvi S, van Heerwaarden R. Anterior closing wedge osteotomy for failed anterior cruciate ligament reconstruction: state of the art. J Am Acad Orthop Surg Glob Res Rev. 2022; 6(9):e22.00044. doi: 10.5435/JAAOSGlobal-D-22-00044.
  4. Mabrouk A, Kley K, Jacquet C, Fayard JM, An JS, Ollivier M. Outcomes of slope-reducing proximal tibial osteotomy combined with a third anterior cruciate ligament reconstruction procedure with a focus on return to impact sports. Am J Sports Med. 2023; 51(13):3454-3463. doi: 10.1177/03635465231203016.
  5. Agostinone P, Lucidi GA, Dal Fabbro G, et al. Satisfactory long-term outcomes for combined anterior cruciate ligament reconstruction and lateral closing wedge high tibial

 

osteotomy. Knee Surg Sports Traumatol Arthrosc. 2023; 31(10):4399-4406. doi: 10.1007/s00167-023-07496-8.

  1. Cance N, Dan MJ, Pineda T, Demey G, DeJour DH. Radiographic investigation of coronal plane and patellar height and changes following tibial deflection osteotomy for correction of tibial slope in combination with ACL reconstruction. Am J Sports Med. 2024; 52(3):691-697. doi: 10.1177/03635465231222643.
  2. Guy S, Saithna A, Ferreira A, et al. The influence of tibial tubercle-sparing slope-reducing osteotomy on patellar height in patients undergoing revision ACL reconstruction. Am J Sports Med. 2024; 52(4):919-927. doi: 10.1177/03635465241228264.
  3. Bosco F, Giustra F, Giai via R, et al. could anterior closed-wedge high tibial osteotomy be a viable option in patients with high posterior tibial slope who undergo anterior cruciate ligament reconstruction? A systematic review and meta-analysis. Eur J Orthop Surg Traumatol. 2023; 33(6):2201-2214. doi: 10.1007/s00590-022-03419-4.
  4. Itthipanichpong T, Uppstrom TJ, V Menta S, Ranawat AS. Systematic review of clinical outcomes after proximal tibia anterior closing-wedge osteotomy with ACL reconstruction. Orthop J Sports Med. 2023; 11(12):23259671231210549. doi: 10.1177/23259671231210549.
  5. Siegel MG. Editorial commentary: when performing proximal tibial slope decreasing osteotomies in patients undergoing primary or revision anterior cruciate ligament reconstruction, surgeons must be cautious to avoid overcorrection of the posterior tibial slope: teeter-totter tibial translation. Arthroscopy 2024; 40(3):855-856. doi: 10.1016/j.arthro.2023.07.024.
  6. Guy S, Saithna A, Ferreira A, et al. The influence of tibial tubercle–sparing slope-reducing osteotomy on patellar height in patients undergoing revision ACL reconstruction. Am J Sports Med. 2024; 52(4):919-927. doi: 10.1177/03635465241228264.
  7. Vivacqua T, Thomassen S, Winkler PW, et al. Closing-wedge posterior tibial slope–reducing osteotomy in complex revision ACL reconstruction. Orthop J Sports Medicine. 2023; 11(1):23259671221144786. doi: 10.1177/23259671221144786.
  8. Dan MJ, Cance N, Pineda T, Demey G, Dejour DH. 4-6 degrees is the target posterior tibial slope post tibial deflection osteotomy according to the knee static anterior tibial translation. Arthroscopy. 2024; 40(3):846-854. doi: 10.1016/j.arthro.2023.07.007.
  9. Mabrouk A, An J-S, Reina Fernandes L, Kley K, Jacquet C, Ollivier M. Maintaining posterior tibial slope and patellar height during medial opening wedge high tibial osteotomy. Orthop J Sports Med. 2023; 11(12):23259671231213595. doi: 10.1177/23259671231213595.
  10. Tensho K, Kumaki D, Yoshida K, Shimodaira H, Horiuchi H, Takahashi J. Posterior opening-wedge osteotomy for posterior tibial slope correction of failed anterior cruciate ligament reconstruction. Arthrosc Tech. 2023; 12(12):e2303-e2311. doi: 10.1016/j.eats.2023.07.059.
  11. Deng F, Li Z, Liu J-C. Osteotomy combined with anterior cruciate ligament (ACL) reconstruction for the treatment of a patient with ACL injury and biplanar deformity. Asian J Surg. 2023; 46(4):1768-1770. doi: 10.1016/j.asjsur.2022.10.020.
  12. Liu J, Li Z, Zhou P. Anterior closing wedge tibial osteotomy for the correction of steep posterior tibial slope and varus knee deformity associated with primary anterior cruciate ligament injury. Asian J Surg. 2023; 46(7):2739-2741. doi: 10.1016/j.asjsur.2023.01.016.
  13. Liu Z, Jiang J, Yi Q, Teng Y, Liu X, He Jm et al. An increased posterior tibial slope is associated with a higher risk of graft failure following ACL reconstruction: a systematic review. Knee Surg Sports Traumatology Arthrosc. 2022; 30(7):2377-2387. doi: 10.1007/s00167-022-06888-6.
  14. Weiler A, Gwinner C, Wagner M, Ferner F, Strobel MJ, Dickschas J. Significant slope reduction in ACL deficiency can be achieved both by anterior closing-wedge and medial open-wedge high tibial osteotomies: early experiences in 76 cases. Knee Surg Sports Traumatology Arthrosc. 2022; 30(6):1967-1975. doi: 10.1007/s00167-022-06861-3.
  15. Guarino A, Pineda T, de Sanctis EG, van Rooij F, Saffarini M, Dejour D. The original technique for tibial deflexion osteotomy during revision anterior cruciate ligament reconstruction: surgical technique. Arthrosc Tech. 2023; 13(1):102824. doi: 10.1016/j.eats.2023.08.029.

 

 

 

 

The Archives of Bone and Joint Surgery
Volume 12, Issue 8
August 2024
Pages 603-607

Files

History

  • Receive Date: 02 March 2024
  • Revise Date: 18 May 2024
  • Accept Date: 19 May 2024

Share

How to cite

Statistics