Knee instability and varus malangulation - Simultaneous cruciate ligament reconstruction and osteotomy (Indication, planning and operative technique, results)

Abstract

Osteochondral lesions and osteoarthritis in young patients are often caused by chronic knee instability in varus malangulated knees. We present the indication, planning of the osteotomy as well as the operative technique and the results of our patients with simultaneous osteotomy and cruciate ligament reconstruction. From 4/96 until 12/00 58 patients ( 33 years) received simultaneous osteotomy (r = 57 correcting valgus, r = 1 varus malalignement) and cruciate ligament plasty (e = 49 ACL, n = 7 PCL, n = 2 ACL & PCL which routinely was performed in the arthroscopic technique after completion of the osteotomy (closed-wedge technique). Average correction angle of the osteotomy was 7 (4 - 10) degrees with a mean malalignement of 5 (0 - 10) degrees. 13 patients underwent additional cartilage surgery (osteochondral autograft transplantation, autologous chondrocyte transplantation, microfracturing), 2 patients received an implanted Collagen Meniscus (CMI) at the same time. Preoperatively the Lysholm score was 66 (35 - 81) points and increased to 81 (74 - 95), 87 (79 - 99) and 93 (88 - 99) points at 3, 6, and 12 months after surgery, respectively. 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 were noted in 4 patients. Unstable varus malangulated knees can be sufficiently treated by osteotomy and cruciate ligament plasty at the same time, suggesting that unicompartimental decompression and treatment of instability is a causal and cost effective therapy delaying the progression of osteoarthritis and minimising clinical symptoms. Performing both operations in one procedure facilitates early rehabilitation and return of these patients to the activities of daily living and sports.