Arthroscopic reconstruction of the anterior cruciate ligament combined with proximal tibial osteotomy: case report

Background

Poor outcomes of anterior cruciate ligament (ACL) reconstruction represent a significant clinical challenge in modern orthopedics, especially in the presence of concomitant biomechanical disorders, such as varus deformity and medial osteoarthritis (OA) of the knee. Thus, despite the advances in surgical techniques, about 20–30% of patients continue to experience instability or pain after intervention, which may be due to various factors, including anatomical features, improper surgical technique, complications after surgical intervention. This can lead to the progression of osteoarthritis and a significant decrease in the patient's quality of life. The purpose of this study is to evaluate the clinical effectiveness of simultaneous arthroscopic reconstruction of the PCL and proximal tibial osteotomy (PTO) in patients with knee instability and varus deformity, as combining these two procedures appears to be a promising approach. CLINICAL CASE DESCRIPTION: This paper presents a clinical case of simultaneous arthroscopic reconstruction of the anterior cruciate ligament (ACL) and proximal tibial osteotomy (PTO) in a 39-year-old patient with varus deformity, knee joint instability, and Kellgren-Lawrence grade II medial osteoarthritis (OA). The patient presented with complaints of right knee instability for 10 years following a football injury and increased pain syndrome over the past year. Preoperative examination showed knee function scores of 60 on KOOS, 48 on KSS1, 60 on KSS2, and pain level of 60mm on VAS. MRI revealed grade4 chondromalacia of the medial femoral and tibial condyles, complete ACL tear, and varus deformity of 7.9°. The patient underwent simultaneous ACL reconstruction using hamstring tendons combined with high tibial osteotomy. At 18months post-surgery, significant improvement in functional parameters was observed: 81points on KOOS, 81points on KSS1, 90points on KSS2, with pain reduction to 15mm on VAS. Repeat arthroscopy showed Koshino gradeB articular cartilage regeneration on the medial condyles, with preserved ACL graft functionality.

Conclusion

This case demonstrates the effectiveness of combined ACL reconstruction and PTO in treating patients with long-term knee instability and concomitant osteoarthritis.