Moradi Amin, Sadeghpour Alireza, Khalilpour Akbar
Orthopedic Department, Shohada Hospital, Tabriz University of Medical Science, Tabriz, Iran.
Arch Bone Jt Surg. 2020 Jul;8(4):537-544. doi: 10.22038/abjs.2020.46686.2286.
Nowadays combined high tibial osteotomy and ACL reconstruction is accepted as a safe and effective surgery for patients with symptomatic varus osteoarthritis and anterior knee instability; however, the source of varus deformity is sometimes the femoral bone. No studies have reported concomitant ACL reconstruction and distal femoral osteotomy in ACL-deficient knees with femoral varus deformity and medial osteoarthritis till now. This prospective study presents the technique and clinical outcome of a consecutive series of simultaneous lateral closed-wedge distal femoral osteotomy and ACL reconstruction.
Nineteen patients with confirmed ACL rupture and femoral varus deformity (mechanical lateral distal femoral angle ≥ 93°) associated with medial osteoarthritis (± lateral thrust) were included the study. The patients underwent simultaneous lateral closed-wedge distal femoral osteotomy and ACL reconstruction. At the end of one year follow up, the final range of motion and stability of the knees and the last alignment of extremities were recorded. Surgical outcomes were assessed on 2000 IKDS subjective scores and KOOS subscales.
The mean preoperative varus knee was 10.6° (±2.2°) mostly from the femoral side. The mean union time was 3.2 (±0.4) months. Regarding the radiological evaluation, the alignment of extremity and mLDFA were corrected significantly compared to the pre-operative findings. At the end of one year follow up, all patients were free of knee instability. Subjective assessment based on questionnaires showed a significant improvement in all aspects of knee function after surgery, however there was no considerable change in the knees range of motion.
Simultaneous lateral closed- wedge distal femoral osteotomy and ACL reconstruction is a valuable procedure in femoral varus knees with medial osteoarthritis and anterior knee instability. After one year follow up all aspects of knee function were improved without serious complications.
如今，对于有症状的膝内翻骨关节炎和膝关节前侧不稳定患者，高位胫骨截骨术联合前交叉韧带重建术被认为是一种安全有效的手术；然而，膝内翻畸形的来源有时是股骨。迄今为止，尚无研究报道在伴有股骨内翻畸形和内侧骨关节炎的前交叉韧带损伤膝关节中同时进行前交叉韧带重建和股骨远端截骨术。本前瞻性研究介绍了一系列连续的外侧闭合楔形股骨远端截骨术和前交叉韧带重建术的技术及临床结果。
19例确诊为前交叉韧带断裂且伴有股骨内翻畸形（机械性股骨外侧远端角≥93°）并伴有内侧骨关节炎（±外侧推力）的患者纳入本研究。患者同时接受外侧闭合楔形股骨远端截骨术和前交叉韧带重建术。在随访一年结束时，记录膝关节的最终活动范围、稳定性以及肢体的最终对线情况。根据2000IKDS主观评分和KOOS子量表评估手术效果。
术前平均膝内翻角度为10.6°（±2.2°），主要源于股骨侧。平均愈合时间为3.2（±0.4）个月。影像学评估显示，与术前相比，肢体对线和mLDFA得到显著矫正。随访一年结束时，所有患者均无膝关节不稳定情况。基于问卷调查的主观评估显示，术后膝关节功能的各个方面均有显著改善，然而膝关节活动范围无明显变化。
外侧闭合楔形股骨远端截骨术联合前交叉韧带重建术对于伴有内侧骨关节炎和膝关节前侧不稳定的股骨内翻膝关节是一种有价值的手术方法。随访一年后，膝关节功能的各个方面均得到改善，且无严重并发症。
