SIMULTANEOUS TREATMENT OF OSTEOARTHRITIS OF MEDIAL COMPARTMENT WITH POSTERIOR CRUCIATE LIGAMENT INJURY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 LIUBingli , WANGXue , DAIShifeng

Department of Joint Surgery, Tangshan No. 2 Hospital, Tangshan Hebei, 063000, P. R. China;

Corresponding author：

LIUBingli, Email: gukelaoliu@126.com

Keywords：

Medial compartment osteoarthritis; High tibia osteotomy; Posterior cruciate ligament reconstruction

DOI：

10.7507/1002-1892.20160002

Video：

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Objective To study the results of high tibia osteotomy (HTO) combined with posterior cruciate ligament (PCL) reconstruction for osteoarthritis (OA) of the medial compartment with PCL injury. Methods Between March 2008 and June 2014, 11 patients with OA of the medial compartment and PCL injury underwent HTO combined with PCL reconstruction. There were 5 males and 6 females, aged 43-55 years (mean, 50.3 years). All patients had a trauma history, and the duration of injury was 3-5 years (mean, 3.7 years). At preoperation, Hospital for special surgery (HSS) score was 54.73±8.60, Lysholm score was 56.91±4.51, KT-1000 test was (5.71±1.13) mm, and knee range of motion (ROM) was (125.21±4.77)°. The preoperative femoral tibia angle (FTA) and posterior slope angle (PSA) of the tibia plateau were (184.82±2.40)° and (7.18±1.17)° on the X-ray film. Results Incisional fat liquefaction occurred in 1 case, and wound healed after dressing change; primary healing of wound was obtained in the other cases. All 11 cases were followed up 12-28 months (mean, 17 months). Bone union was observed at osteotomy site within 6 months, without delayed union or nonunion. After operation, genu varus deformity was corrected with different degrees; the stability of knees was improved in all patients; and the pain of medial knee was released significantly. At 12 months after operation, the FTA was significantly reduced to (176.64±1.96)°; at last follow-up, the HSS score was significantly increased to 88.27±4.76, KT- 1000 test was significantly reduced to (3.18±0.87) mm, and Lyholm score was significantly increased to 86.45±2.34, all showing significant differences when compared with preoperative ones (P<0.05). At last follow-up, the knee ROM was (124.63±2.98)° and the PSA was (7.91±1.30)°, showing no significant difference when compared with preoperative ones (P>0.05). Conclusion The PSA will not be changed when a combination of HTO and PCL reconstruction is used to treat OA of the medial compartment with PCL injury if the right osteotomy site and reasonable bone graft are selected. The short-term effectiveness is good because of good recovery of the lower extremity force line and knee stability, but the long-term effectiveness remains to be further followed up.

Citation： LIUBingli, WANGXue, DAIShifeng. SIMULTANEOUS TREATMENT OF OSTEOARTHRITIS OF MEDIAL COMPARTMENT WITH POSTERIOR CRUCIATE LIGAMENT INJURY. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(1): 6-9. doi: 10.7507/1002-1892.20160002 Copy

1.	Fujisawa Y, Masuhara K, Shiomi S. The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am, 1979, 10(3):585-608.
2.	Noyes FR, Goebel SX, West J. Opening wedge tibial osteotomy:the 3-triangle method to correct axial alignment and tibial slope. Am J Sports Med, 2005, 33(3):378-387.
3.	Lattermann C, Jakob RP. High tibial osteotomy alone or combined with ligament reconstruction in anterior cruciate ligament deficient knees. Knee Surg Sports Traumatol Arthrosc, 1996, 4(1):32-38.
4.	Naudie D, Bourne RB, Rorabeck CH, et al. The install award. Survivorship of the high tibial valgus osteotomy. A 10-to-22-year follow up study. Clin Orthop Relat Res, 1999, (367):18-27.
5.	Strobel MJ, Weiler A, Eichhorn HJ. Diagnosis and therapy of fresh and chronic posterior cruciate ligament lesions. Chirurg, 2000, 71(9):1066-1081.
6.	Nagel A, Insall JN, Scuderi GR. Proximal tibial osteotomy:a subjective outcome study. J Bone Joint Surg (Am), 1996, 78(9):1353-1358.
7.	Badhe NP, Forster IW. High tibial osteotomy in knee instability:the rationale of treatment and early results. Knee Surg Sports Traumtol Arthrosc, 2002, 10(1):38-43.
8.	Dejour H, Bonnin M. Tibial translation after anterior cruciate ligament rupture. Two radiological tests compared. J Bone Joint Surg (Br), 1994, 76(5):745-749.
9.	Noyes FR, Barber-Westin SD, Hewett TE. High tibial osteotomy and ligament reconstruction for varus angulated anterior cruciate ligament-deficient knees. Am J Sports Med, 2000, 28(3):282-296.
10.	Lephart SM, Pincivero DM, Rozzi SL. Proprioception of the ankle and knee. Sports Med, 1998, 25(3):149-155.
11.	Cooper JM, McAndrews PT, LaPrade RF. Posterolateral corner injuries of the knee:anatomy, diagnosis, and treatment. Sports Med Arthrosc, 2006, 14(4):213-220.
12.	Grassmayr MJ, Parker DA, Coolican MR, et al. Posterior cruciate ligament deficiency:biomechanical and biological consequences and the outcomes of conservative treatment. A systematic review. J Sci Med Sport, 2008, 11(5):433-443.
13.	Fanelli GC, Fanelli DG. Management of chronic combined PCL medial posteromedial instability of the knee. Sports Med Arthrosc, 2015, 23(2):96-103.
14.	Camarda L, Condello V, Madonna V. Results of isolated posterolateral corner reconstruction. J Orthop Traumatol, 2010, 11(2):73-79.
15.	Lobenhoffer P. Importance of osteotomy around to the knee for medial gonarthritis. Indications, technique and results. Orthopade, 2014, 43(5):425-431.
16.	Neuschwander DC, Drez D Jr, Paine RM. Simultaneous high tibial osteotomy and ACL reconstruction for combined genu varum and symptomatic ACL tear. Orthopedics, 1993, 16(6):679-684.
17.	Noyes FR, Barber-Westin SD, Hewett TE. High tibial osteotomy and ligament reconstruction in varus angulated, anterior cruciate ligament-deficient knees. A two-to seven-year follow-up study. Am J Sports Med, 2000, 28(3):282-296.
18.	Rodner CM, Adams DJ, Diaz-Doran V. Medial opening wedge tibial osteotomy and the sagittal plane:the effect of increasing tibial slope on tibiofemoral contact pressure. Am J Sports Med, 2006, 34(9):1431-1441.
19.	Marti CB, Gautier E, Wachtl SW, et al. Accuracy of frontal and sagittal plane correction in open-wedge high tibial osteotomy. Arthroscopy, 2004, 20(4):366-372.
20.	Naudie DD, Amendola A, Fowler PJ. Opening wedge high tibial osteotomy for symptomatic hyperextension-varus thrust. Am J Sports Med, 2004, 32(1):60-70.
21.	Giffin JR, Vogrin TM, Zantop T, et al. Effects of increasing tibial slope on the biomechanics of the knee. Am J Sports Med, 2004, 32(2):376-382.

1. Fujisawa Y, Masuhara K, Shiomi S. The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am, 1979, 10(3):585-608.
2. Noyes FR, Goebel SX, West J. Opening wedge tibial osteotomy:the 3-triangle method to correct axial alignment and tibial slope. Am J Sports Med, 2005, 33(3):378-387.
3. Lattermann C, Jakob RP. High tibial osteotomy alone or combined with ligament reconstruction in anterior cruciate ligament deficient knees. Knee Surg Sports Traumatol Arthrosc, 1996, 4(1):32-38.
4. Naudie D, Bourne RB, Rorabeck CH, et al. The install award. Survivorship of the high tibial valgus osteotomy. A 10-to-22-year follow up study. Clin Orthop Relat Res, 1999, (367):18-27.
5. Strobel MJ, Weiler A, Eichhorn HJ. Diagnosis and therapy of fresh and chronic posterior cruciate ligament lesions. Chirurg, 2000, 71(9):1066-1081.
6. Nagel A, Insall JN, Scuderi GR. Proximal tibial osteotomy:a subjective outcome study. J Bone Joint Surg (Am), 1996, 78(9):1353-1358.
7. Badhe NP, Forster IW. High tibial osteotomy in knee instability:the rationale of treatment and early results. Knee Surg Sports Traumtol Arthrosc, 2002, 10(1):38-43.
8. Dejour H, Bonnin M. Tibial translation after anterior cruciate ligament rupture. Two radiological tests compared. J Bone Joint Surg (Br), 1994, 76(5):745-749.
9. Noyes FR, Barber-Westin SD, Hewett TE. High tibial osteotomy and ligament reconstruction for varus angulated anterior cruciate ligament-deficient knees. Am J Sports Med, 2000, 28(3):282-296.
10. Lephart SM, Pincivero DM, Rozzi SL. Proprioception of the ankle and knee. Sports Med, 1998, 25(3):149-155.
11. Cooper JM, McAndrews PT, LaPrade RF. Posterolateral corner injuries of the knee:anatomy, diagnosis, and treatment. Sports Med Arthrosc, 2006, 14(4):213-220.
12. Grassmayr MJ, Parker DA, Coolican MR, et al. Posterior cruciate ligament deficiency:biomechanical and biological consequences and the outcomes of conservative treatment. A systematic review. J Sci Med Sport, 2008, 11(5):433-443.
13. Fanelli GC, Fanelli DG. Management of chronic combined PCL medial posteromedial instability of the knee. Sports Med Arthrosc, 2015, 23(2):96-103.
14. Camarda L, Condello V, Madonna V. Results of isolated posterolateral corner reconstruction. J Orthop Traumatol, 2010, 11(2):73-79.
15. Lobenhoffer P. Importance of osteotomy around to the knee for medial gonarthritis. Indications, technique and results. Orthopade, 2014, 43(5):425-431.
16. Neuschwander DC, Drez D Jr, Paine RM. Simultaneous high tibial osteotomy and ACL reconstruction for combined genu varum and symptomatic ACL tear. Orthopedics, 1993, 16(6):679-684.
17. Noyes FR, Barber-Westin SD, Hewett TE. High tibial osteotomy and ligament reconstruction in varus angulated, anterior cruciate ligament-deficient knees. A two-to seven-year follow-up study. Am J Sports Med, 2000, 28(3):282-296.
18. Rodner CM, Adams DJ, Diaz-Doran V. Medial opening wedge tibial osteotomy and the sagittal plane:the effect of increasing tibial slope on tibiofemoral contact pressure. Am J Sports Med, 2006, 34(9):1431-1441.
19. Marti CB, Gautier E, Wachtl SW, et al. Accuracy of frontal and sagittal plane correction in open-wedge high tibial osteotomy. Arthroscopy, 2004, 20(4):366-372.
20. Naudie DD, Amendola A, Fowler PJ. Opening wedge high tibial osteotomy for symptomatic hyperextension-varus thrust. Am J Sports Med, 2004, 32(1):60-70.
21. Giffin JR, Vogrin TM, Zantop T, et al. Effects of increasing tibial slope on the biomechanics of the knee. Am J Sports Med, 2004, 32(2):376-382.

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SIMULTANEOUS TREATMENT OF OSTEOARTHRITIS OF MEDIAL COMPARTMENT WITH POSTERIOR CRUCIATE LIGAMENT INJURY

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