Simultaneous anterior cruciate ligament reconstruction and opening wedge high tibial osteotomy: Report of four cases

Abstract 

Four patients, aged 37–50 years, with chronic anterior cruciate ligament (ACL) deficiency, medial compartment osteoarthritis and varus deformity, underwent simultaneous arthroscopic ACL reconstruction and opening wedge high tibial osteotomy using the TomoFix fixation device and hydroxyapatite wedges. The simultaneous procedure allowed our patients to perform a full weight-bearing exercise at 4 weeks after surgery. At device removal and concomitant second-look arthroscopy, all patients had either a cyclops-like lesion or partial tears at the point of contact between the reconstructed ACL and intercondylar notch. Therefore, subsequent notchplasty or re-notchplasty was required.

Because of the small number of patients, the results should be considered preliminary. Given our findings of graft morbidity caused by the corrected postoperative alignment, adequate intercondylar notchplasty should be performed at the initial operation.

Keywords: Anterior cruciate ligament, High tibial osteotomy, Knee, Osteoarthritis, Simultaneous operation