Abstract
Several factors must be analyzed before treating anterior chronic laxity. We know that the presence of preoperative radiological degenerative changes can induce osteoarthritis after anterior cruciate ligament (ACL) reconstruction. The occurrence of frontal imbalance or sagittal imbalance can also induce an early osteoarthritis. ACL reconstruction combined with valgus tibial osteotomy is reported in the literature in cases of frontal imbalance. Sagittal imbalance is not very well understood. Sagittal imbalance can be caused by ACL rupture, posterior horn of the medial meniscus tear, and excessive tibial slope. Comparative monopodal-stance profile radiographs at 30° of flexion are necessary to analyze sagittal imbalance and to detect early degenerative changes. We recommend ACL reconstruction with tibial deflexion osteotomy in cases of evolved anterior chronic laxity with pre osteoarthritis, a condition involving partial femorotibial narrowing of the medial compartment and large differential anterior tibial translation (>10 mm) on monopodal-stance profile radiograph. Tibial deflexion osteotomy can reduce the tibial slope and thereby decrease the anterior tibial translation and prevent distension of the ACL graft.
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