Corrective osteotomy in primary varus, double varus and triple varus knee instability with cruciate ligament replacement

Abstract

Osteochondral lesions and osteoarthritis in young patients are often caused by chronic knee instability in varus malaligned knees. We present the indication, operative technique, and results of 57 patients treated by simultaneous high tibial osteotomy and cruciate ligament reconstruction. The indication for simultaneous high tibial valgus osteotomy and ACL reconstruction is chronic anterior knee instability in varus knees of patients under 40 years of age. In these patients, medial meniscus deficiency secondary to prior injuries and/or chronic knee instability have frequently led to unicompartmental (medial) tibiofemoral degenerative changes. The average correction angle of the osteotomy was 7 degrees (4-10). Subjectively, all patients reported an improvement of preoperative swelling, pain, and instability. Additional cartilage surgery or meniscus implantation did not significantly alter the clinical score values. Complications occurred in four patients. Unstable varus malangulated knees can be sufficiently treated by osteotomy and cruciate ligament plasty and is suggested as cost-effective therapy with good short-term results. Performing both operations in one procedure facilitates early rehabilitation and return of the patients back to the activities of daily living and sports.