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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 4/2020

01-04-2020 | Osteoarthrosis | KNEE

Excellent long-term results in combined high tibial osteotomy, anterior cruciate ligament reconstruction and chondral resurfacing in patients with severe osteoarthritis and varus alignment

Authors: Philipp Schuster, Michael Schlumberger, Philipp Mayer, Martin Eichinger, Markus Geßlein, Martin Schulz-Jahrsdörfer, Jörg Richter

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 4/2020

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Abstract

Purpose

To determine survivorship and functional results of medial open-wedge high tibial osteotomy (HTO) combined with anterior cruciate ligament reconstruction (ACLR) and a chondral resurfacing (CR) procedure (abrasion/microfracture) in patients with Kellgren-Lawrence grade 3 and 4 osteoarthritis with full thickness-cartilage defects, ACL-insufficiency and varus alignment.

Methods

A cohort of 23 patients undergoing a combined procedure of HTO (fixation with angular stable internal fixator, Tomofix®), ACLR and CR for the treatment of severe symptomatic medial osteoarthritis, ACL insufficiency and varus alignment (> 4°) between 2005 and 2009 was prospectively surveyed with a minimum follow-up of 10 years with regard to survival (not requiring arthroplasty), functional outcome (subjective IKDC score), pain level (numeric rating scale), Oxford Knee Score (OKS) and subjective satisfaction. The Wilcoxon signed-rank-test was used for statistical evaluation of non-parametric data in these related samples.

Results

Twenty-one cases were included, one case with incomplete follow-up data and another case excluded. The follow-up rate was 91% at 12.0 ± 1.0 years (10.0–13.4). Mean age at time of surgery was 47.3 ± 5.9 years (37.8–57.7). At final follow-up, no arthroplasty was performed in any of the cases (survival: 100%). Subjective IKDC score improved from 47 ± 11 to 75 ± 15 at 1, 72 ± 15 at 3, 73 ± 17 at 6 years and 70 ± 16 at final follow-up (p < 0.001), respectively. At final follow-up the OKS was 40 ± 7 (17–48) and pain-level significantly decreased from 7.5 ± 1.0 preoperatively to 2.9 ± 2.3 (p < 0.001) at final follow-up. All patients were satisfied with the result and stated that they would retrospectively undergo the procedure again.

Conclusion

A combined approach of HTO, ACLR and a CR shows excellent results in a long-term follow-up in selected young patients even in severe osteoarthritis. However, the role and potential benefit of the ACLR and CR compared to HTO alone remains unclear.

Level of evidence

Therapeutic case series, Level IV.
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Metadata
Title
Excellent long-term results in combined high tibial osteotomy, anterior cruciate ligament reconstruction and chondral resurfacing in patients with severe osteoarthritis and varus alignment
Authors
Philipp Schuster
Michael Schlumberger
Philipp Mayer
Martin Eichinger
Markus Geßlein
Martin Schulz-Jahrsdörfer
Jörg Richter
Publication date
01-04-2020
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 4/2020
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-019-05671-4

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