الفهرس 
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Abstract
Anterior cruciate ligament (ACL) tear induces progressive
deterioration in knee structures. In the meniscus, secondary
lesions are often medial, occurring within 5 to 10 years after the
ligament lesion, and are followed by cartilage lesions that lead
to osteoarthritis.
Osteoarthritis involves usually the medial tibiofemoral
compartment, especially following medial meniscectomy. ACL
reconstruction achieves knee stability and can limit the
osteoarthritic process. Valgus high tibial osteotomy (HTO)
limits the evolution of medial tibiofemoral osteoarthritis in varus
knees.
Combined ACL reconstruction and valgus HTO (ACLHTO)
stabilizes the knee and counters osteoarthritic evolution.
The present study is a systematic review discussing the
simultaneous versus staged anterior cruciate ligament (ACL)
reconstruction and opening wedge high tibial osteotomy as
regard clinical outcomes and complications, eight studies were
included with a total of number of patients = 222 with average
age ranged from 35.4 to 54.2 years, they were 172 male and 50
female.
The results of our study showed a highly statistical
significant difference (to HTO-ACLR group) between the
included studies regarding type of operation and the majority of
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the patients were treated with hamstrings autograft, and a small
minority had a patellar Bone-to-Bone autograft.
One study compared between HTO group and HTOACLR
group according to Kellgren-Lawrence (KL) scale
preoperatively and found a highly statistically significant
difference (to HTO-ACLR group) between both group but no
difference found after follow up with a highly significant
difference in each group between preoperative and after follow
up. A significant statistical difference (to HTO-ACLR group)
between grades of Kellgren-Lawrence (KL) scale was reported
in comparing two groups (HTO / HTO-ACLR) in 2 studies at
follow-up.
A highly significant statistical difference (to HTO-ACLR
group) between both groups (HTO / HTO-ACLR) regarding
subjective IKDC score at follow up. There was a non-statistically
significant difference was found between preoperative and at
follow up regarding the mean posterior tibial slope between both
groups.
After comparing both groups in five studies we reported a
high statistically significant difference (to HTO-ACLR group)
between preoperative and after follow up of mean mechanical
axis of the knee.
Surgery revisions were reported in 10 patients (HTO = 1
patient), while in simultaneous procedure group there was a
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deficit of range of motion reported in 7 patients and graft failure
was mentioned in 15 patients.
In conclusion, and based on our results, we cannot
recommend one procedure rather than other as these papers are
not enough for sure recommendation, more control trials are
needed to clarify better choice.