Combined ACL reconstruction and closing-wedge HTO for varus angulated ACL-deficient knees

Stefano Zaffagnini, Tommaso Bonanzinga, Alberto Grassi, Giulio Maria Marcheggiani Muccioli, Costanza Musiani, Federico Raggi, Francesco Iacono, Vittorio Vaccari, Maurilio Marcacci

Research output: Contribution to journalArticle


Purpose: To report the medium-term clinical and radiographic outcomes of a group of patients who underwent anterior cruciate ligament (ACL) surgery combined with high tibial osteotomy (HTO) for varus-related early medial osteoarthritis (OA) and ACL deficiency knee. Methods: Thirty-two patients underwent single-bundle over-the-top ACL reconstruction or revision surgery and a concomitant closing-wedge lateral HTO. The mean age at surgery was 40. 1 ± 8. 1 years. Evaluation at a mean of 6. 5 ± 2. 7 years of follow-up consisted of subjective and objective IKDC, Tegner Activity Level, EQ-5D, VAS for pain and AP laxity assessment with KT-1000 arthrometer. Limb alignment and OA changes were evaluated on radiographs. Results: All scores significantly improved from pre-operative status to final follow-up. KT-1000 evaluation showed a mean side-to-side difference of 2. 2 ± 1. 0 mm. Two patients were considered as failures. The mean correction of the limb alignment was 5. 6° ± 2. 8°. Posterior tibial slope decreased at a mean of 1. 2° ± 0. 9°. At final follow-up, the mechanical axes crossed the medial-lateral length of tibial plateau at a mean of 56 ± 23 %, with only 1 patient (3 %) presenting severe varus alignment. OA progression was recorded only on the medial compartment (p = 0. 0230), with severe medial OA in 22 % of the patients. No patients underwent osteotomy revision, ACL revision, UKA or TKA. Conclusions: The described technique allowed patients with medial OA, varus alignment and chronic ACL deficiency to restore knee laxity, correct alignment and resume a recreational level of activity at 6. 5 years of follow-up. Level of evidence: Case series with no comparison group, Level IV.

Original languageEnglish
Pages (from-to)934-941
Number of pages8
JournalKnee Surgery, Sports Traumatology, Arthroscopy
Issue number4
Publication statusPublished - 2013



  • ACL
  • Alignment
  • Early osteoarthritis
  • Knee
  • Laxity
  • Osteotomy

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

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