simultaneous high tibial osteotomy and anterior cruciate ligament reconstruction in knees with bony frontal and/or sagittal deformities: review of the current literature

Simultaneous anterior cruciate ligament (acl) reconstruction (aclr) and valgus high tibial osteotomy (hto) alleviates pain in 70% of individuals with acl deficiency and varus femorotibial osteoarthritis, allows for sustainable stabilization of the knee at the 10-year follow-up and a return to sport (rts) in 33%-80% of cases, but femorotibial osteoarthritis progression occurs in 39% of cases. the complication rate ranges from 0% to 23.5% (6.5% revision valgus hto, 17.5% acl graft failure, 7.7% venous thrombosis). simultaneous aclr and hto leads to satisfactory results in patients with acl deficiency and varus femorotibial osteoarthritis associated with a high posterior tibial slope (pts) and appears to have a protective effect on further ruptures in the reconstructed acl. the younger the patient and the more sporting demands he/she poses, the more we should be inclined to perform a combined intervention (aclr and valgus hto).        level of evidence: iii