Orthopedic and Traumatology Impacts on Psychological Health Due to Simultaneous Lateral Open-Wedge Varus Osteotomy with Acl Revision: Importance of Coronal Alignment and Stability Restoration to Improve Acl Graft Survival

Abstract

Introduction: The success and long-term effectiveness of any knee surgery or reconstruction heavily depend on the accurate alignment and positioning of knee components. Therefore, this case report aims to examine the importance of managing sagittal and coronal imbalance to maintain the survival of the graft, especially in cases with deformity and instability in the coronal plane.

Objectives: The primary objective of this case report is to highlight the significance of managing sagittal and coronal imbalance in ACL ruptures with associated deformities and coronal instability.

Methods: A retrospective analysis was conducted on an eighteen-year-old male patient who presented with right knee pain and a history of ACL reconstruction and valgus deformity. The patient underwent a second operation involving osteotomy, ACL revision, and reattachment of the proximal avulsion of the MCL. Physical examination findings and MRI results were evaluated to assess the effectiveness of managing sagittal and coronal imbalance.

Results: The physical examination revealed the presence of valgus deformity, a scar from the first surgery, and no signs of infection, but with no tenderness and limitation of the right knee ROM. MRI indicated a proximal avulsion of the MCL. Following the second operation involving osteotomy and revision of ACL with reattachment of the MCL avulsion, improvements in knee alignment and stability were observed.

Conclusions: The findings of this case report highlight the crucial role of addressing sagittal and coronal imbalance in ACL ruptures with associated deformities and coronal instability. Correcting malalignment alongside ACL repair, particularly in severe cases, can significantly contribute to maintaining the survival of the graft and improving the long-term outcomes of knee surgeries.