Abstract
The purpose of this study was to evaluate the role of high tibial osteotomy (HTO) [Lateral closed wedge v/s medial open wedge] in varus aligned knees with ligament instability. (ACL, PCL, PLRl).
We treated 14 patients with knee instability and varus alignment with HTO with or without ligament reconstruction. 5 patients with varus angulated ACL deficiency (double varus) were treated with single stage closed wedge HTO and ACL reconstruction. Of the remaining nine patients with PCL + PLRI injuries with varus angulation (Triple varus), six were treated with LARS ligament reconstruction with HTO, and the remaining were treated with HTO without ligament reconstruction. Four of these patients with triple varus had a open wedge HTO and the remaining five patients had a closed wedge HTO.
The mean time interval between injury and index surgery was 8.3 years. At a mean follow-up of 2.8 years 12 knees (86%) were stable and eliminated of giving way. In one patient the result was compromised with severe infection. Five patients (35%) continued to have varying degree of pain. According to the Cincinnati knee scoring system there were eight good, four fair and two poor results. In patients with triple varus, open wedge HTO had better scores than closed wedge HTO.
The results of this series are encouraging and we recommend HTO with ligament reconstruction in these complex cases.
The abstracts were prepared by Mr Roger Smith. Correspondence should be addressed to him c/o British Orthopaedic Association, Royal College of Surgeons, 35-42 Lindoln’s Inn Fields, London WC2A 3PN.
