الفهرس | Only 14 pages are availabe for public view |
Abstract Anterior cruciate ligament (ACL) tear induces progressive deterioration in knee structures. In the meniscus, secondary lesions are often medial, occurring within 5 to 10 years after the ligament lesion, and are followed by cartilage lesions that lead to osteoarthritis. Osteoarthritis involves usually the medial tibiofemoral compartment, especially following medial meniscectomy. ACL reconstruction achieves knee stability and can limit the osteoarthritic process. Valgus high tibial osteotomy (HTO) limits the evolution of medial tibiofemoral osteoarthritis in varus knees. Combined ACL reconstruction and valgus HTO (ACLHTO) stabilizes the knee and counters osteoarthritic evolution. The present study is a systematic review discussing the simultaneous versus staged anterior cruciate ligament (ACL) reconstruction and opening wedge high tibial osteotomy as regard clinical outcomes and complications, eight studies were included with a total of number of patients = 222 with average age ranged from 35.4 to 54.2 years, they were 172 male and 50 female. The results of our study showed a highly statistical significant difference (to HTO-ACLR group) between the included studies regarding type of operation and the majority of References 60 the patients were treated with hamstrings autograft, and a small minority had a patellar Bone-to-Bone autograft. One study compared between HTO group and HTOACLR group according to Kellgren-Lawrence (KL) scale preoperatively and found a highly statistically significant difference (to HTO-ACLR group) between both group but no difference found after follow up with a highly significant difference in each group between preoperative and after follow up. A significant statistical difference (to HTO-ACLR group) between grades of Kellgren-Lawrence (KL) scale was reported in comparing two groups (HTO / HTO-ACLR) in 2 studies at follow-up. A highly significant statistical difference (to HTO-ACLR group) between both groups (HTO / HTO-ACLR) regarding subjective IKDC score at follow up. There was a non-statistically significant difference was found between preoperative and at follow up regarding the mean posterior tibial slope between both groups. After comparing both groups in five studies we reported a high statistically significant difference (to HTO-ACLR group) between preoperative and after follow up of mean mechanical axis of the knee. Surgery revisions were reported in 10 patients (HTO = 1 patient), while in simultaneous procedure group there was a References 61 deficit of range of motion reported in 7 patients and graft failure was mentioned in 15 patients. In conclusion, and based on our results, we cannot recommend one procedure rather than other as these papers are not enough for sure recommendation, more control trials are needed to clarify better choice. |