Reconstruction of the anterior cruciate ligament against the backdrop of gonarthrosis
Objective: To develop techniques for differential selection of indications for surgical treatment of anterior knee instability on the backdrop of osteoarthritis (OA). Methods: long-term outcomes were analyzed in 149 patients (86 men, 63 women) aged 36–63 years with knee OA which operated from 2 to 12 years ago. We assessed a stage of OA, medial tibial angle, tibial slope, area and extent of the cartilage damage, and a degree of joint space narrowing. Results: tactic of choice for surgical treatment in patients with injuries of the anterior crucial ligament (ACL) on the backdrop of gonarthrosis I–II stages was defined. Generally indications enunciated in patients up to 55 years. Plastic of the ACL on the backdrop of gonarthrosis in patients with a body mass index over 30 remains a subject of debate. The tendency for better results was observed in men. In patients aged up to 60 years without varus deformity in case of presence of an articular cartilage damage one may perform plastic of the ACL with predictable good outcomes. In case of damage of the articular cartilage III–IV stages up to 4 cm2 one may perform chondroplasty or substitution of the defect. Varus deformity or large cartilage defects more than 4 cm2 is an indication for the simultaneous reconstruction of the ACL and valgization osteotomy. If in patients with varus deformity and damage of the ACL there is big tibial slope (11º or more) it is necessary to make a correction of varus deformity and to reduce a tibial slop. Conclusions: Chronic anterior instability leads to deterioration of cartilage in the medial part. Restoration of stability of the knee joint due to plastic of the ACL and change of geometry in the frontal and sagittal planes through valgization and reducing of a tibial slope facilitate reducing of mechanical loading on the graft cartilage and slower abrasion of the cartilage. Issues arising in cases of reconstruction of the ACL against the backdrop of gonarthrosis remain unsolved and proposed criteria are controversial.
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