Short term outcomes of anterior cruciate ligament reconstruction with and without high tibial osteotomy in knees with mild degree varus malalignment. Comparative study.

Abstract

Anterior cruciate ligament reconstruction (ACLR) restores stability but does not prevent medial osteoarthritis in ACL deficient varus knees due to uneven load. High tibial osteotomy (HTO) corrects varus alignment, potentially reducing graft failure when combined with ACLR. However, the combined procedure is technically demanding with greater risks. This study compares ACLR alone versus combined HTO in mild varus knees, expecting similar outcomes if not associated with varus thrust or laxity. This study enrolled patients aged 18-50 with ACL-deficient knees and varus malalignment with tibio-femoral angle (TFA) 7-10°. Exclusion criteria included severe osteoarthritis (Kellgren-Lawrence grade III and IV), varus thrust, other ligament laxities, limited flexion <120°, or BMI >30. Group A underwent ACLR alone, while Group B had combined ACLR with HTO. All patients provided consent and followed the same rehabilitation protocols. The study of 24 patients (12 ACLR, 12 ACLR + HTO) found comparable baseline characteristics and outcomes. Both groups showed significant improvements in Lysholm and Tegner scores, regained range of motion by 12 months, and had mostly negative Lachman tests. Return to play was around 7 months. The combination of ACLR and HTO in ACL-deficient knees with mild varus showed outcomes and functional scores like ACLR alone at 12 months, without added morbidity or delayed rehab. No clinical or statistical differences were found between groups. Thus, HTO is not mandatory without varus thrust, though long-term follow-up is needed to assess graft survival and failure rates comprehensively. Level II.