Philipp Schuster1, Markus Geßlein2, Michael Schlumberger3, Philipp Mayer3, Jörg Richter3. 1. Orthopedic Hospital Markgroeningen, Centre for Arthroscopy and Sports Medicine, Kurt-Lindemann-Weg, Markgröningen, Germany. Electronic address: philipp_schuster@gmx.de. 2. Paracelsus Medical Private University, Clinic Nuremberg, Department of Orthopedics and Traumatology, Breslauer Str., Nürnberg, Germany. 3. Orthopedic Hospital Markgroeningen, Centre for Arthroscopy and Sports Medicine, Kurt-Lindemann-Weg, Markgröningen, Germany.
Abstract
BACKGROUND: Young patients with severe medial osteoarthritis, varus malalignment and insufficiency of the anterior cruciate ligament (ACL) are difficult to treat. The tibial slope has gained attention with regard to osteotomies and ligamentous instability. The purpose was to evaluate the outcome of combined high tibial osteotomy (HTO), ACL reconstruction and chondral resurfacing (CR, abrasion plus microfracture), and to analyse graft failure rates with regard to the tibial slope. METHODS: Fifty cases (48.9 ± 5.4 years) of combined HTO, ACLR and CR were retrospectively analysed with regard to survival, functional outcome (subjective International Knee Documentation Committee (IKDC) examination form) and subjective satisfaction. The tibial slope was determined on lateral radiographs and analysed with regard to its influence on graft functionality at the time of hardware removal. RESULTS: Follow-up rate was 100% after 5.6 ± 1.6 years. No arthroplasties were performed. Subjective IKDC score was 70 ± 18, and 94% were satisfied with the result. The graft was intact in 39 cases (78%), and non-functional in 11 cases (22%). No significant changes were present in pre- and postoperative tibial slope (P = 0.811). Graft insufficiency was strongly dependent on tibial slope, with a failure rate of seven percent in cases of postoperative tibial slope <7.5°, 24% in cases of 7.5-12.5°, and 36% in cases of >12.5°. CONCLUSION: Combined HTO, ACLR and CR is an effective treatment in these cases. The graft failure rate increases with an increase in tibial slope, in particular when exceeding 12.5°. LEVEL OF EVIDENCE: Case series, Level 4.
BACKGROUND: Young patients with severe medial osteoarthritis, varus malalignment and insufficiency of the anterior cruciate ligament (ACL) are difficult to treat. The tibial slope has gained attention with regard to osteotomies and ligamentous instability. The purpose was to evaluate the outcome of combined high tibial osteotomy (HTO), ACL reconstruction and chondral resurfacing (CR, abrasion plus microfracture), and to analyse graft failure rates with regard to the tibial slope. METHODS: Fifty cases (48.9 ± 5.4 years) of combined HTO, ACLR and CR were retrospectively analysed with regard to survival, functional outcome (subjective International Knee Documentation Committee (IKDC) examination form) and subjective satisfaction. The tibial slope was determined on lateral radiographs and analysed with regard to its influence on graft functionality at the time of hardware removal. RESULTS: Follow-up rate was 100% after 5.6 ± 1.6 years. No arthroplasties were performed. Subjective IKDC score was 70 ± 18, and 94% were satisfied with the result. The graft was intact in 39 cases (78%), and non-functional in 11 cases (22%). No significant changes were present in pre- and postoperative tibial slope (P = 0.811). Graft insufficiency was strongly dependent on tibial slope, with a failure rate of seven percent in cases of postoperative tibial slope <7.5°, 24% in cases of 7.5-12.5°, and 36% in cases of >12.5°. CONCLUSION: Combined HTO, ACLR and CR is an effective treatment in these cases. The graft failure rate increases with an increase in tibial slope, in particular when exceeding 12.5°. LEVEL OF EVIDENCE: Case series, Level 4.
Authors: Philipp Schuster; Michael Schlumberger; Philipp Mayer; Martin Eichinger; Markus Geßlein; Martin Schulz-Jahrsdörfer; Jörg Richter Journal: Knee Surg Sports Traumatol Arthrosc Date: 2019-08-19 Impact factor: 4.342