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First published on January 25, 2006, doi:10.1177/0363546505283269
This version was published on June 1, 2006
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The American Journal of Sports Medicine 34:961-967 (2006)
© 2006 American Orthopaedic Society for Sports Medicine

Anatomical Double-Bundle Anterior Cruciate Ligament Reconstruction After Valgus High Tibial Osteotomy

A Biomechanical Study

Robert H. P. Kilger, MD, Jens Stehle, MD, Jesse A. Fisk, MS, Maribeth Thomas, Kazutomo Miura, MD and Savio L-Y. Woo, PhD, DSc*

From the Musculoskeletal Research Center, Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania

* Address correspondence to Savio L-Y. Woo, PhD, DSc, Musculoskeletal Research Center, 405 Center for Bioengineering, 300 Technology Drive, P.O. Box 71199, Pittsburgh, PA 15213 (e-mail: ddecenzo{at}pitt.edu).

Background: Although anatomical double-bundle anterior cruciate ligament reconstruction can successfully restore normal knee biomechanics for knees with typical varus-valgus alignment, the efficacy of the same reconstruction method for knees after a valgus high tibial osteotomy is unclear.

Hypothesis: Anatomical double-bundle anterior cruciate ligament reconstruction for valgus knees after a high tibial osteotomy cannot restore normal knee kinematics and can result in abnormally high in situ forces in the ligament graft.

Study Design: Controlled laboratory study.

Methods: Ten cadaveric knees were subjected to valgus high tibial osteotomy followed by an anatomical double-bundle anterior cruciate ligament reconstruction. The valgus knees were tested using a robotic/universal force-moment sensor system before and after the ligament reconstruction. The knee kinematics in response to anterior tibial load and combined rotatory loads, as well as the corresponding in situ forces of the anterior cruciate ligament bundles and grafts, were compared between the ligament-intact and ligament-reconstructed valgus knees.

Results: After reconstruction, the anterior tibial translation and internal tibial rotation for the valgus knee decreased approximately 2 mm and 2°, respectively, at low flexion angles compared with those of the anterior cruciate ligament–intact knee (P < .05). The in situ forces in the posterolateral graft became 56% to 200% higher than those in the posterolateral bundle of the intact anterior cruciate ligament (P < .05).

Conclusion: Performing an anatomical double-bundle anterior cruciate ligament reconstruction on knees after valgus high tibial osteotomy may overconstrain the knee and result in high forces in the posterolateral graft, which could predispose it to failure.

Clinical Relevance: Modifications of anterior cruciate ligament reconstruction procedures to reduce posterolateral graft force may be needed for valgus knees after a high tibial osteotomy.

Key Words: anterior cruciate ligament (ACL) • double-bundle reconstruction • high tibial osteotomy • in situ force • posterolateral (PL) graft






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