Department of Orthopaedic Surgery, Groupement Hospitalier Nord, University Lyon 1, 103 Grande rue de la Croix-Rousse, 69004, Lyon, France.
Univ Lyon, IFSTTAR, LBMC, UMR_T9406, Université Claude Bernard Lyon 1, 69622, Lyon, France.
Knee Surg Sports Traumatol Arthrosc. 2020 Mar;28(3):960-968. doi: 10.1007/s00167-019-05592-2. Epub 2019 Jul 13.
The purpose of this study was to report the long-term outcomes of a continuous series of patients who underwent simultaneous anterior cruciate ligament (ACL) reconstruction and opening wedge high tibial osteotomy (HTO) for varus-related early medial tibio-femoral osteoarthritis. It was hypothesized that this combined surgery sustainably allowed return to sport with efficient clinical and radiological results.
From 1995 to 2015, all combined ACL reconstruction (bone-patellar tendon-bone graft) and opening wedge HTO for anterior laxity and early medial arthritis were included. Clinical evaluation at final follow-up used Tegner activity score, Lysholm score, subjective and objective IKDC scores. Radiologic evaluation consisted in full-length, standing, hip-to-ankle X-rays, monopodal weight-bearing X-rays and skyline views. AP laxity assessment used Telos™ at 150 N load. Student's t test was performed for matched parametric data, Wilcoxon for nonparametric variables and Friedman test was used to compare small cohorts, with p < 0.05.
35 Patients (36 knees) were reviewed with a mean follow-up of 10 ± 5.2 years. The mean age at surgery was 39 ± 9. At final follow-up 28 patients (80%) returned to sport (IKDC ≥ B): 11 patients (31%) returned to sport at the same level and 6 (17%) to competitive sports. Mean subjective IKDC and Lysholm scores were 71.8 ± 14.9 and 82 ± 14.1, respectively. The mean decrease of the Tegner activity level from preinjury state to follow-up was 0.8 (p < 0.01). Mean side-to-side difference in anterior tibial translation was 5.1 ± 3.8 mm. Three patients were considered as failures. The mean preoperative mechanical axis was 4.2° ± 2.6° varus and 0.8° ± 2.7° valgus at follow-up. Osteoarthritis progression for medial, lateral, and femoro-patellar compartments was recorded for 12 (33%, p < 0.05), 6 (17%, p < 0.001), and 8 (22%, p < 0.05) knees, respectively. No femoro-tibial osteoarthritis progression was observed in 22 knees (61%).
Combined ACL reconstruction and opening wedge HTO allowed sustainable stabilization of the knee at 10-year follow-up. However, return to sport at the same level was possible just for one-third of patients, with femoro-tibial osteoarthritis progression in 39% of cases.
III.
本研究旨在报告一组连续接受前交叉韧带（ACL）重建和开放式楔形胫骨高位截骨术（HTO）治疗与内翻相关的早期内侧胫骨股骨骨关节炎患者的长期结果。研究假设，这种联合手术可通过高效的临床和影像学结果，使患者可持续地恢复运动。
1995 年至 2015 年，所有接受 ACL 重建（骨-髌腱-骨移植物）和开放式楔形 HTO 治疗的患者均包括在内。最终随访时的临床评估采用 Tegner 活动评分、Lysholm 评分、主观和客观 IKDC 评分。影像学评估包括全长、站立、髋-踝 X 线片、单足负重 X 线片和天幕位 X 线片。使用 Telos™ 在 150 N 负荷下评估前向松弛度。对于匹配的参数数据，使用学生 t 检验；对于非参数变量，使用 Wilcoxon 检验；对于小样本队列，使用 Friedman 检验，p 值均小于 0.05。
共 35 例患者（36 膝）接受了回顾性分析，平均随访时间为 10±5.2 年。手术时的平均年龄为 39±9 岁。最终随访时，28 例患者（80%）恢复运动（IKDC≥B）：11 例（31%）回到与术前相同水平的运动，6 例（17%）回到竞技运动。平均主观 IKDC 和 Lysholm 评分分别为 71.8±14.9 和 82±14.1。与术前相比，Tegner 活动水平的平均下降为 0.8（p<0.01）。前胫骨平移的平均侧间差值为 5.1±3.8mm。3 例患者被认为是失败病例。术前机械轴平均为 4.2°±2.6°内翻和 0.8°±2.7°外翻，随访时分别为 4.2°±2.6°内翻和 0.8°±2.7°外翻。内侧、外侧和股骨-髌骨关节间隙的骨关节炎进展分别记录到 12 例（33%，p<0.05）、6 例（17%，p<0.001）和 8 例（22%，p<0.05）膝关节。22 例膝关节（61%）未观察到股胫关节骨关节炎进展。
ACL 重建和开放式楔形 HTO 的联合治疗可在 10 年随访时稳定膝关节，但只有三分之一的患者能恢复到术前相同的运动水平，39%的患者出现股胫关节骨关节炎进展。
III 级。
