High tibial osteotomy and ligament reconstruction for varus angulated anterior cruciate ligament-deficient knees

In a consecutive series, we treated 41 young patients who had anterior cruc iate ligament deficiency, lower limb varus angulation, and varying amounts of posterolateral ligament deficiency. Seventy-three percent of the patient s (N = 30) had lost the medial meniscus and 63% (N = 26) had marked articul ar cartilage damage in the medial compartment. All patients were treated wi th high tibial osteotomy and, in the majority (N = 34), anterior cruciate l igament reconstruction a mean of 8 months later. Posterolateral reconstruct ions were also required in 18 knees. A 100% follow-up was obtained at a mea n of 4.5 years after osteotomy, Gait analysis testing was done in 17 knees before and after osteotomy. At follow-up, a reduction in pain was found in 71% (29 knees); elimination of giving way, in 85% (35 knees); and resumptio n of light recreational activities without symptoms, in 66% (27 knees). The patient rating of the knee condition was normal or very good in 37% (15 kn ees) and good in 34% (14 knees). The mean Cincinnati Knee Rating Score sign ificantly improved from 63 to 82 points. The mean adduction moment, 35% hig her than controls preoperatively, significantly decreased to below normal v alues postoperatively. Correction of varus alignment was maintained in 33 k nees (80%). We recommend osteotomy in addition to ligament reconstructive p rocedures in these knees with complex injury patterns.