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Concomitant lateral meniscus repair
5%
42/774
Varus deformity
64%
499/774
Posterior tibial slope
24%
185/774
Graft choice
3%
26/774
Degree of patellofemoral arthrosis
1%
10/774
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Varus deformity in the setting of anterior cruciate ligament (ACL) reconstruction places the new graft at higher risk of failure if not addressed before or during the procedure. ACL tears are common injuries that occur more in a younger, athletic population, typically with non-contact, pivoting injuries. Concomitant injury to the menisci, articular cartilage, PCL, or collateral ligaments can occur. Before ACL reconstruction is undertaken, surgeons must critically evaluate several anatomic factors including the patient's alignment; this should be done on full-length radiographs of the bilateral lower extremities and both the coronal and sagittal planes should be evaluated. Significant varus deformity has been shown to increase the risk of failure after ACL reconstruction, as has an increase in posterior tibial slope. Osteotomies of the tibia can be performed prior to or at the time of ACL reconstruction in order to address the alignment abnormalities. Rossi et al. reviewed the role of high tibial osteotomy (HTO) in the varus knee. They note that indications include medial compartment arthrosis/overload, knee instability with bony malalignment, and osteochondral defects in order to unload the compartment. They detail further different techniques that can be performed alone or in combination with soft tissue procedures to address these issues. Noyes et al. evaluated HTO and ACL reconstruction in patients with excessive varus angulation. Most patients were treated in a staged manner with HTO, followed by ACL reconstruction +/- posterolateral corner reconstruction. They found that the addition of the HTO resulted in reduction of pain and instability symptoms as well as an improvement in function. Incorrect Answers: Answer 1: Lateral meniscus repair at the same time as ACL reconstruction does not increase the risk of ACL failure; in fact, healing factors associated with the meniscus tear may be beneficial to ACL graft healing. Answer 3: Posterior tibial slope >12º has been consistently shown as a risk factor for ACL graft failure, and can be addressed with a deflexion osteotomy (anterior closing wedge) of the tibia. Answer 4: The use of a bone-patellar tendon-bone autograft is considered the gold standard in ACL reconstruction and would not increase the risk of graft failure. Answer 5: Mild patellofemoral arthrosis does not increase the risk of ACL graft failure after reconstruction.
4.5
(4)
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