Combined anterior closing-wedge high tibial osteotomy and anterior cruciate ligament reconstruction for treating chronic anterior cruciate ligament injury with increased posterior tibial slope / 中华骨科杂志

ABSTRACT

Objective:To investigate the short-term clinical outcomes of patients who received combined anterior closing-wedge high tibial osteotomy (ACW-HTO) and anterior cruciate ligament (ACL) reconstruction in treating chronic ACL injury with increased posterior tibial slope (PTS).Methods:From January 2017 to June 2018, a total of 54 patients (46 males and 8 females, mean age 30.8±3.9 years, range from 20 to 42 years) with chronic (time from injury to surgery was more than 6 months) ACL injury and increased PTS (>17°) were retrospectively analyzed. Eighteen of them received combined ACW-HTO and ACL reconstruction (ACW-HTO+ACL reconstruction group), while the remaining 36 received isolated ACL reconstruction (ACL reconstruction group). The demographic data, pre-operative and post-operative anterior tibial translation, pivot-shift result, KT-1000 side-to-side difference, subjective Lysholm score, Tegner activity score, and International Knee Documentation Committee (IKDC) objective grading system were collected and compared between the two groups.Results:There were no significant differences between the two groups in terms of age, sex, body mass index, time from injury to surgery and proportion of patients with concomitant medial or lateral meniscus tear ( P>0.05). At 2-year's follow-up, the anterior tibial translation in the ACW-HTO+ACL reconstruction group was 0.9±0.4 mm, which was significantly smaller than that in the ACL reconstruction group 7.3±1.5 mm ( t=10.049, P<0.001). Moreover, there was significant difference in the pivot-shift result between the two groups (ACW-HTO+ACL reconstruction group 18 low-grade vs. ACL reconstruction group 31 low-grade, 5 high-grade) (χ 2=16.071, P<0.001). The KT-1000 side-to-side difference in the ACW-HTO+ACL reconstruction group was 1.5±0.6 mm, which was significantly smaller than that in the ACL reconstruction group 4.4±1.2 mm ( t=13.858, P<0.001). In addition, the subjective Lysholm score in the ACW-HTO+ACL reconstruction group was 93.3±4.3, which was significantly higher than that in the ACL reconstruction group 80.3±6.3 ( t=12.176, P<0.001). The Tegner activity score in the ACW-HTO+ACL reconstruction group was 7.3±0.9, which was significantly higher than that in the ACL reconstruction group 6.8±0.6 ( t=6.356, P=0.043). There was significant difference in terms of the IKDC objective grading system between the two groups (ACW-HTO+ACL reconstruction group 17 grade A, 1 grade B vs. ACL reconstruction group 29 grade A, 5 grade B, 2 grade C) (χ 2=12.351, P<0.001). Conclusion:The combined ACW-HTO and ACL reconstruction showed superior short-term knee stability and functional scores compared with the isolated ACL reconstruction in treating chronic ACL injury with increased PTS.