The clinical Outcome of One-stage High Tibial Osteotomy and Anterior Cruciate Ligament Reconstruction. A Current Concept Systematic and Comprehensive Review

Background: Patients with an anterior cruciate ligament-deficient varus-angulated knee may need not only an isolated high tibial osteotomy (HTO), but also an additional anterior cruciate ligament reconstruction (ACLR). A number of prospective clinical trials have been published considering the combination of HTO and ACL reconstruction. Our aim was to investigate whether one-stage combined HTO and ACL reconstruction is an effective, well-established technique with long-term results in the treatment of varus-angu lated knees with ACL deficiency. Methods: A systematic review was conducted by two independent reviewers by searching the MEDLINE/PubMed and the Cochrane Database of Systematic Reviews. These databases were queried with the term ‘combined high tibial osteotomy anterior cruciate ligament reconstruction’ and ‘simultaneous high tibial osteotomy anterior cruciate ligament reconstruction’. Results: From the initial 41 studies we finally chose and assessed 6 studies were eligible according to our inclusionexclusion criteria. The vast majority of the patients were treated with hamstrings autograft (85.6% of the patients), whereas a small minority had a patellar Bone-to-Bone autograft (12.8% of the patients) and 3 patients received a patellar allograft. High tibial open wedge osteotomy was performed in 116 patients (57.4%) and closed wedge in 86 patients (42.6%). The mean pre-operative angle of the patients included in our review was 6.6º varus, while the mean final post-operative angle was found to be 1.3º valgus. All 6 studies illustrated improved post-operative IKDC with the use of one-stage HTO and ACLR, whereas the reoperation rate was very low. Conclusion: Despite the lack of high quality studies, it seems that one-stage HTO and ACLR is a safe and effective procedure for treatment of patients suffering from symptomatic varus osteoarthritis in combination with anterior knee instability. Level of evidence: II