Anterior cruciate ligament reconstruction combined with valgus high tibial osteotomy allows return to sports

IntroductionThis study reports a series of patients operated on by anterior cruciate ligament (ACL) reconstruction combined with valgus high tibial osteotomy (HTO) for chronic anterior knee instability associated with medial tibiofemoral osteoarthritis. It was hypothesized that the combined surgery would enable return to sport, stabilize the knee and relieve medial pain.Patients and methodsA retrospective study enrolled a continuous series of 29 patients (20 males, nine females; mean age, 43 years (range, 25–56 yrs), at a mean 14 years (range, 2–29 yrs) after the initial injury. ACL autograft used a bone-patellar tendon-bone transplant in 12 patients and hamstring tendon transplant in 17. Medial opening wedge HTO used an asymmetric wedge plate. Results were assessed on subjective and objective IKDC scores, monopodal weight-bearing and full-leg radiographs, telemetry and Merchant view at a mean 6 years follow-up (range, 25 months to 12 years).ResultsAt follow-up, 23 patients had resumed sports activities, with 45% in competitive sports; 28 were free of instability and 21 free of pain. Mean subjective IKDC score was 77 (34–97) and 70% had A or B global objective IKDC scores. The knee axis was in 2.5° valgus.DiscussionCombined ACL graft and valgus HTO relieved pain in 70% of cases, and restored knee stability enabling return to sport in 80%.Level of evidenceLevel IV. Retrospective therapeutic study.