The Clinical Outcome of Simultaneous Lateral Closed- Wedge Distal Femoral Osteotomy and Anterior Cruciate Ligament Reconstruction in the ACL-deficient Knees with Symptomatic Femoral Varus Deformity

Background: Nowadays combined high tibial osteotomy and ACL reconstruction is accepted as a safe and effectivesurgery for patients with symptomatic varus osteoarthritis and anterior knee instability; however, the source of varusdeformity is sometimes the femoral bone. No studies have reported concomitant ACL reconstruction and distal femoralosteotomy in ACL-deficient knees with femoral varus deformity and medial osteoarthritis till now. This prospectivestudy presents the technique and clinical outcome of a consecutive series of simultaneous lateral closed-wedge distalfemoral osteotomy and ACL reconstruction.Methods: Nineteen patients with confirmed ACL rupture and femoral varus deformity (mechanical lateral distal femoralangle ≥ 93°) associated with medial osteoarthritis (± lateral thrust) were included the study. The patients underwentsimultaneous lateral closed-wedge distal femoral osteotomy and ACL reconstruction. At the end of one year followup, the final range of motion and stability of the knees and the last alignment of extremities were recorded. Surgicaloutcomes were assessed on 2000 IKDS subjective scores and KOOS subscales.Results: The mean preoperative varus knee was 10.6° (±2.2°) mostly from the femoral side. The mean union timewas 3.2 (±0.4) months. Regarding the radiological evaluation, the alignment of extremity and mLDFA were correctedsignificantly compared to the pre-operative findings. At the end of one year follow up, all patients were free of kneeinstability. Subjective assessment based on questionnaires showed a significant improvement in all aspects of kneefunction after surgery, however there was no considerable change in the knees range of motion.Conclusion: Simultaneous lateral closed- wedge distal femoral osteotomy and ACL reconstruction is a valuableprocedure in femoral varus knees with medial osteoarthritis and anterior knee instability. After one year follow up allaspects of knee function were improved without serious complications.Level of evidence: IV