If You Have a Patient Who is a Candidate for a High Tibial Osteotomy and ACL Reconstruction, Should You Perform a 1-Stage or 2-Stage Procedure?
Before answering this question it is important again to emphasize that chronic anterior cruciate ligament (ACL) deficiency in active patients continues to lead to progressive deterioration of the articular cartilage of the tibio-femoral joint, most commonly the medial compartment. Patients who have had a previous medial meniscectomy or have preexisting varus are at higher risk of the progression of medial compartment arthritis. The outcomes following ACL reconstruction in ACL-deficient patients have demonstrated adequate control of anterior translation; however, in patients who present with chronic ACL deficiency with early arthritis, isolated ACL reconstruction alone probably does not prevent the progression of further arthritis, particularly if the patient remains active and continues in pivoting sports. High tibial osteotomy (HTO) in patients with early medial compartment arthrosis has been shown to be an effective method of reducing symptoms and possibly reducing the progression of osteoarthritis in these patients. 1 Patients who present with both ACL deficiency and malalignment with medial compartment overload have been shown to benefit from high tibial osteotomy and ACL reconstruction in both a 1-stage or 2-stage procedure. 1-5 Whether these procedures should be performed in these types of patients in a 1-stage or 2-stage fashion still remains controversial because of the technical difficulty of performing the 1-stage procedure as well as the additional possible risk of increased morbidity by performing both procedures at the same time.
