The role of osteotomy in the multiple ligament injured knee

Abstract

Reconstruction of the knee with multiple ligament injuries can be challenging due to the many factors necessary to achieve a stable, functional joint. Assessing limb alignment and malalignment has been largely ignored in the multiple ligament injured knee and reconstruction has focused on soft tissue constraints. Although it has been shown that joint alignment plays a critical role in the development of arthritis and overload syndromes, osteotomy to control instability has been a controversial subject. Recent evidence suggests that joint alignment may be just as important in maintaining joint stability, particularly in cases of chronic ligamentous injury. Over time, untreated malalignment can worsen ligamentous laxity and lead to symptomatic chronic instability. In the case of the anterior cruciate ligament (ACL)-deficient knee, for example, varus malalignment can be overemphasized as internal rotation of the tibia places more stress on the lateral structures. This deformity can then be manifested as a posterolateral thrust on ambulation. Malalignment in the cervical or sagittal plane may be a significant contributing factor in the success of ligamentous reconstruction. The purpose of this article is to discuss the role of osteotomy in these unstable knees as a means of insuring success in the long-term outcome of ligamentous reconstruction.