Anterior cruciate ligament reconstruction with anterior closing wedge osteotomy for failed high tibial osteotomy-A case report.
Anterior closing wedge osteotomy
Anterior cruciate ligament
Opening wedge high tibial osteotomy
Posterior tibial slope
Journal
International journal of surgery case reports
ISSN: 2210-2612
Titre abrégé: Int J Surg Case Rep
Pays: Netherlands
ID NLM: 101529872
Informations de publication
Date de publication:
2020
2020
Historique:
received:
01
06
2020
revised:
24
06
2020
accepted:
25
06
2020
pubmed:
18
7
2020
medline:
18
7
2020
entrez:
18
7
2020
Statut:
ppublish
Résumé
Increased posterior tibial slope (PTS) is considered a risk factor for anterior cruciate ligament (ACL) injury. Previous studies revealed that medial opening wedge high tibial osteotomy (OWHTO) tends to increase PTS. However, knee instability from increased PTS is not a reported complication after OWHTO, and the treatment strategy is unclear. A 55-year-old woman who complained of left knee pain underwent OWHTO for early-stage medial compartment osteoarthritis by another doctor. After the first surgery, her left knee pain decreased; however, 1 year after OWHTO, she began to feel left knee instability, and the primary doctor consulted our clinic. Physical examination revealed a positive Lachman's test, and radiographs showed that PTS had increased from 8 degrees to 15 degrees. According to these findings, we diagnosed an aggravated symptomatic knee instability secondary to increased PTS after OWHTO. We then performed ACL reconstruction using the quadriceps tendon and tibial anterior closing wedge osteotomy (ACWO), which is a newly-developed technique to correct PTS for revision ACL reconstruction. Postoperatively, PTS was corrected from 15 degrees to 7 degrees, and the patient's Lysholm score improved from 39 to 95, 1 year postoperatively. ACL reconstruction with ACWO is a possible treatment option for the PTS-increased knee after OWHTO.
Sections du résumé
BACKGROUND
BACKGROUND
Increased posterior tibial slope (PTS) is considered a risk factor for anterior cruciate ligament (ACL) injury. Previous studies revealed that medial opening wedge high tibial osteotomy (OWHTO) tends to increase PTS. However, knee instability from increased PTS is not a reported complication after OWHTO, and the treatment strategy is unclear.
METHODS
METHODS
A 55-year-old woman who complained of left knee pain underwent OWHTO for early-stage medial compartment osteoarthritis by another doctor. After the first surgery, her left knee pain decreased; however, 1 year after OWHTO, she began to feel left knee instability, and the primary doctor consulted our clinic. Physical examination revealed a positive Lachman's test, and radiographs showed that PTS had increased from 8 degrees to 15 degrees. According to these findings, we diagnosed an aggravated symptomatic knee instability secondary to increased PTS after OWHTO. We then performed ACL reconstruction using the quadriceps tendon and tibial anterior closing wedge osteotomy (ACWO), which is a newly-developed technique to correct PTS for revision ACL reconstruction.
RESULTS
RESULTS
Postoperatively, PTS was corrected from 15 degrees to 7 degrees, and the patient's Lysholm score improved from 39 to 95, 1 year postoperatively.
CONCLUSIONS
CONCLUSIONS
ACL reconstruction with ACWO is a possible treatment option for the PTS-increased knee after OWHTO.
Identifiants
pubmed: 32679316
pii: S2210-2612(20)30506-X
doi: 10.1016/j.ijscr.2020.06.102
pmc: PMC7364120
pii:
doi:
Types de publication
Case Reports
Langues
eng
Pagination
116-120Informations de copyright
Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of Competing Interest We wish to confirm that there are no conflicts of interest associated with this publication.
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