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.
A cohort of 23 patients undergoing a combined procedure of HTO (fixation with angular stable internal fixator, Tomofix
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.
Therapeutic case series, Level IV.
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.