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Satisfactory long-term outcomes for combined anterior cruciate ligament reconstruction and lateral closing wedge high tibial osteotomy

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

A combined anterior cruciate ligament (ACL) reconstruction and high tibial osteotomy (HTO) is considered a valuable treatment in young patients affected by symptomatic medial osteoarthritis and ACL deficiency. However, only a few studies have investigated the outcomes of this procedure, especially in the long term. Therefore, the aim of this study is to report clinical and radiographic outcomes of ACL reconstruction and lateral closing wedge HTO at a mean of 14 years of follow-up.

Methods

Patients were prospectively evaluated pre-operatively, after 6.5 ± 2.7 years and 14.3 ± 2.2 years. Patient-reported outcome measures (PROMs) were collected, knee laxity was assessed through KT-1000 arthrometer, and limb alignment and knee osteoarthritis were evaluated on long-cassette radiographs. Survivorship of the surgical procedure was calculated through the Kaplan–Meier method.

Results

32 patients were initially enrolled and completed the mid-term evaluation (6.5 ± 2.7 years), and 23 patients (72%) were available for the final evaluation at 14.3 ± 2.2 years after surgery. Statistically significant improvement was found for all the clinical scores (VAS, WOMAC, Tegner, subjective IKDC, objective IKDC) between the pre-operative status and the mid-term follow-up (p < .001). VAS, subjective IKDC and objective IKDC showed no statistically significant differences (p > .05) between the mid-term and the final follow-up; a significant decrease of WOMAC (p < .05) and Tegner (p < .001) was found from mid-term to final follow-up. Significant progression of osteoarthritis was found for all the knee compartments. The survivorship was 95.7% at 5 years, 82.6% at 10 years, and 72.8% at 15 years.

Conclusions

Combined ACL reconstruction and lateral closing wedge HTO showed satisfactory clinical outcomes and survivorship at a mean of 14 years follow-up.

Level of evidence

IV.

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Abbreviations

ACL:

Anterior cruciate ligament

ACLR:

Anterior cruciate ligament reconstruction

HTO:

High tibial osteotomy

OA:

Osteoarthritis

PROMs:

Patient-reported outcome measures

VAS:

Visual analog scale

WOMAC:

Western Ontario and McMaster Universities Arthritis Index

IKDC:

International Knee Documentation Committee

KOOS:

Knee Injury and Osteoarthritis Outcome Score

HKA:

Hip–knee–ankle angle

DLFA:

Distal lateral femoral anlge

PTS:

Posterior tibial slope

TP%:

Tibial plateau percentage

UKA:

Unicompartimental knee arthroplasty

MPTA:

Medial proximal tibial angle

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Funding

Authors received no funding for the present study.

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Authors and Affiliations

  1. Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Cesare Pupilli 1, 40136, Bologna, BO, Italy

    Piero Agostinone, Gian Andrea Lucidi, Giacomo Dal Fabbro, Anna Pagano, Marianna Viotto, Maria Pia Neri, Alberto Grassi & Stefano Zaffagnini

  2. Dipartimento di Scienze per la Qualità. della Vita QUVI, Università di Bologna, Bologna, Italy

    Stefano Di Paolo

  3. Dipartimento di Scienze Biomediche e Neuromotorie, DIBINEM, Università di Bologna, Bologna, Italy

    Stefano Zaffagnini

Authors
  1. Piero Agostinone
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  2. Gian Andrea Lucidi
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  3. Giacomo Dal Fabbro
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  4. Stefano Di Paolo
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  5. Anna Pagano
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  6. Marianna Viotto
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  7. Maria Pia Neri
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  8. Alberto Grassi
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  9. Stefano Zaffagnini
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Corresponding author

Correspondence to Piero Agostinone.

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Conflict of interest

Stefano Zaffagnini is a consultant surgeon for Smith and Nephew and DePuy Synthes.

Ethical approval

The study was approved by the Institutional Review Board of Istituto Ortopedico Rizzoli (Prot. 2/CE/US/ml). All the patients signed the informed consent.

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Agostinone, P., Lucidi, G.A., Dal Fabbro, G. et al. Satisfactory long-term outcomes for combined anterior cruciate ligament reconstruction and lateral closing wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 31, 4399–4406 (2023). https://doi.org/10.1007/s00167-023-07496-8

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