Closing wedge HTO after inadequate ACL


Jay is someone with an interesting and complex problem with his left knee which I hope is now sorted out with an osteotomy procedure.

I first met Jay back in May 2017. He had undergone an ACL procedure with a lateral tenodesis (a graft reinforcement of the side of the knee) and sadly never really did well following the surgery. He had a constant lateral pain which was making the knee feel stiff and took at least five minutes to get going and he had pain such that he was limping. He really felt very slowed down as a result of the pain that he was experiencing.

At the time of the original procedure it looked like it was an isolated ACL injury but in fact, looking at the X-rays, he clearly had some injury to the lateral compartment of his knee as the alignment had changed to valgus whereas the opposite side was fairly neutral.

I had a look inside the knee with the arthroscope back in May 2017. The knee was unstable and so was the ACL reconstruction, which hadn't worked, and there was a very prominent screw from the lateral reconstruction (which I removed) and some minor damage laterally. Overall the joint surface and the shock absorbers (menisci) were in good shape.

Having removed the screw I was hoping that things would settle down but Jay continued to experience really quite severe lateral knee pain and after a further six months I elected to do an osteotomy to take his alignment back to neutral. He had a closing wedge tibial osteotomy which is not the most common procedure that we do, although we are doing more and more of these where we want to correct deformity that is valgus and we find that the correction is needed in the tibia as opposed to the femur. We can cater for a 5.2mm correction which is what I carried out three and a half weeks ago and Jay has done extremely well.

I am delighted to say that all of his lateral knee pain has already gone and he has recovered more quickly from this procedure than his original ACL procedure. He doesn't use his crutches now around the house and only uses them when he is out and about. He walks completely pain free and he is off all pain medication, and has been since the end of the second week. You can see from the way he walks today that he has a very mild limp but overall he has a comfortable gait and this is a true testament to the new techniques that we have developed in osteotomy surgery and the strong plates that allow early mobilisation as can be seen with Jay. At 22 years of age he was very disabled and I am delighted to have corrected his alignment and sorted out his chronic lateral knee pain and allowed him to get back on his feet so quickly.

Adrian Wilson

Adrian Wilson

At 22 years of age Jay was very disabled and I am delighted to have corrected his alignment and sorted out his chronic lateral knee pain and allowed him to get back on his feet so quickly.

long leg x-ray
high tibial osteotomy
high tibial osteotomy
after high tibial osteotomy

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