Management of degenerative arthritis following Chronic ACL and LCL injuries man
A 46 year old lady presented with a 9 year old combined Acl and LCL deficiency.
She has a varus thrust, signs of ACL and Lcl deficiency. X ray shows medial deviation of the mechanical axis and degenerative changes in the medial compartment.
What should be the definitive management?
1) Open wedge high tibial osteotomy followed by ligamentous reconstruction
2) Osteotomy alone
3) Standard total knee replacement with an Oxinium prosthesis
4) Total knee replacement with a Hinge knee.
If there is a grade I arthrosis, and the other two compartments are clear, i would go with the n° 1 [osteotomy and reconstruction]
9 years ACL and LCL deficiency--------->TKA but question standard or with Hinge?
Open wedge osteotomy. After 9 years of no function LCA and LCP no great sense in ligament reconstruction
I would not consider to reconstruct the central pivot in this case, whatever the symptom be pain or instabiility. The question is about a definitive treatment. Osteotomies are temporary. They rarelly lead to definitive results but are usefull to postpone an eventual arthroplasty. First of all we have to realign the limb and later on evaluate the necessity or not to reconstruct the ligaments, in case of persistent instability. Or even decide for the joint substitution when pain recurrs and become intractable.
i would like to go with the answer option 1).
pt is just 46 yr old and .. but only unicompartment (medial) is involved.
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