Long-term follow up of single-stage anterior cruciate ligament reconstruction and high tibial osteotomy and its relation with posterior tibial slope
Long-term follow up of single-stage anterior cruciate ligament reconstruction and high tibial osteotomy and its relation with posterior tibial slope
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DOI：
10.1007/s00402-015-2385-5
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发表时间：
2016-04-01
影响因子：
2.3
通讯作者：
Kishore, Chandan
中科院分区：
文献类型：
--
作者：
Arun, G. R.;Kumaraswamy, Vinay;Kishore, Chandan
开放式胫骨高位截骨术被认为是治疗内侧间室骨关节炎的有效方法。一般认为，开式胫骨高位截骨术后胫骨坡度增加，而闭式胫骨高位截骨术后胫骨坡度减小。患有前交叉韧带（ACL）缺陷并伴有内侧间室骨关节炎的年轻患者需要结合 ACL 重建和胫骨高位截骨术，以恢复膝关节生理运动学并避免软骨损伤。我们回顾性分析了 2004 年 1 月至 2012 年 6 月期间接受关节镜 ACL 重建和内侧开口楔形截骨术的 30 例患者的数据，随访时间至少为 2 年。测量术前和术后胫骨后斜度。使用临床放射学标准、IKDC 评分和 Lysholm 评分对功能结果进行分析。术后患者的临床和功能均得到改善。与减少小于 5A 度的患者相比，胫骨后坡度减少 > 5A 度的患者具有更好的功能评分（IKDC 和 Lysholm 评分），具有统计学意义（p < 0.05）。我们的研究表明，与术前相比，胫骨后坡度减少 > 5A 度对重建 ACL 移植物和结果具有良好的功能影响。众所周知，增加坡度会导致胫骨静止位置前移，这种情况在轴向载荷下会加剧。这表明减小胫骨坡度可能对 ACL 缺陷的膝关节起到保护作用。因此，通过将三皮质移植物放置在开口楔中的中线后方，可以减少胫骨后坡度，从而减少移植物上的应力，从而获得更好的功能结果。
Open-wedge high tibial osteotomy is considered to be an effective treatment for medial compartmental osteoarthritis. It is generally admitted that tibial slope increases after open-wedge high tibial osteotomy and decreases after closing-wedge high tibial osteotomy. Young patients with anterior cruciate ligament (ACL) deficiency along with medial compartment osteoarthritis need a combined procedure of ACL reconstruction along with high tibial osteotomy to regain physiological knee kinematics and to avoid chondral damage.We retrospectively analysed data from 30 patients who underwent arthroscopic ACL reconstruction along with medial opening-wedge osteotomy from Jan 2004 to June 2012 with a minimum follow up of 2 years. The pre-operative and post-operative posterior tibial slopes were measured. Functional outcome was analysed using clinico-radiological criteria, IKDC scoring and Lysholm score.Post-operative patients improved both clinically and functionally. The patients who had posterior tibial slope > 5A degrees decrease, compared to patients who had less < 5A degrees decrease, had better functional scores (IKDC and Lysholm score), which was statistically significant (p < 0.05).Our study has shown that decreasing the tibial slope > 5A degrees compared to pre-operative value has functionally favourable effect on the reconstructed ACL graft and outcome. It is known that increasing slope causes an anterior shift in tibial resting position that is accentuated under axial loads. This suggests that decreasing tibial slope may be protective in an ACL deficient knee. Hence by placing the tricortical graft posterior to midline in the opening wedge reduces the posterior tibial slope and thereby reduces the stress on the graft leading to better functional outcome.