Reconstruction of the knee with multiple ligament injuries can be challenging due
to the many factors necessary to achieve a stable, functional joint. Assessing limb
alignment and malalignment has been largely ignored in the multiple ligament injured
knee and reconstruction has focused on soft tissue constraints. Although it has been
shown that joint alignment plays a critical role in the development of arthritis and
overload syndromes, osteotomy to control instability has been a controversial subject.
Recent evidence suggests that joint alignment may be just as important in maintaining
joint stability, particularly in cases of chronic ligamentous injury. Over time, untreated
malalignment can worsen ligamentous laxity and lead to symptomatic chronic instability.
In the case of the anterior cruciate ligament (ACL)-deficient knee, for example, varus
malalignment can be overemphasized as internal rotation of the tibia places more stress
on the lateral structures. This deformity can then be manifested as a posterolateral
thrust on ambulation. Malalignment in the cervical or sagittal plane may be a significant
contributing factor in the success of ligamentous reconstruction. The purpose of this
article is to discuss the role of osteotomy in these unstable knees as a means of
insuring success in the long-term outcome of ligamentous reconstruction.
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© 2003 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
