The Clinical Outcome of Simultaneous Lateral Closed- Wedge Distal Femoral Osteotomy and Anterior Cruciate Ligament Reconstruction in the ACL-deficient Knees with Symptomatic Femoral Varus Deformity

Abstract

Background: Nowadays combined high tibial osteotomy and ACL reconstruction is accepted as a safe and effective<br />surgery for patients with symptomatic varus osteoarthritis and anterior knee instability; however, the source of varus<br />deformity is sometimes the femoral bone. No studies have reported concomitant ACL reconstruction and distal femoral<br />osteotomy in ACL-deficient knees with femoral varus deformity and medial osteoarthritis till now. This prospective<br />study presents the technique and clinical outcome of a consecutive series of simultaneous lateral closed-wedge distal<br />femoral osteotomy and ACL reconstruction.<br />Methods: Nineteen patients with confirmed ACL rupture and femoral varus deformity (mechanical lateral distal femoral<br />angle ≥ 93°) associated with medial osteoarthritis (± lateral thrust) were included the study. The patients underwent<br />simultaneous lateral closed-wedge distal femoral osteotomy and ACL reconstruction. At the end of one year follow<br />up, the final range of motion and stability of the knees and the last alignment of extremities were recorded. Surgical<br />outcomes were assessed on 2000 IKDS subjective scores and KOOS subscales.<br />Results: The mean preoperative varus knee was 10.6° (±2.2°) mostly from the femoral side. The mean union time<br />was 3.2 (±0.4) months. Regarding the radiological evaluation, the alignment of extremity and mLDFA were corrected<br />significantly compared to the pre-operative findings. At the end of one year follow up, all patients were free of knee<br />instability. Subjective assessment based on questionnaires showed a significant improvement in all aspects of knee<br />function after surgery, however there was no considerable change in the knees range of motion.<br />Conclusion: Simultaneous lateral closed- wedge distal femoral osteotomy and ACL reconstruction is a valuable<br />procedure in femoral varus knees with medial osteoarthritis and anterior knee instability. After one year follow up all<br />aspects of knee function were improved without serious complications.<br />Level of evidence: IV