ACL Reconstruction vs. High Tibial Osteotomy: Which Surgery is Better? - Orthopedics

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When considering the choice between ACL reconstruction and High Tibial Osteotomy (HTO), it's essential to understand the underlying conditions of your knee and the goals of each surgical procedure. Both surgeries serve different purposes and have distinct implications for your knee's function and long-term health.

ACL Reconstruction is primarily aimed at restoring the stability of the knee joint after an ACL tear. This procedure involves replacing the torn ligament with a graft, which can be taken from your hamstring tendons or patellar tendon. The goal is to restore the knee's ability to withstand the forces exerted during activities like running, jumping, and pivoting. However, if there is significant damage to the knee joint, such as arthritis or misalignment, simply reconstructing the ACL may not address the underlying issues, which could lead to persistent pain and instability.

On the other hand, High Tibial Osteotomy is a procedure designed to realign the knee joint to distribute weight more evenly across the joint surfaces. This is particularly beneficial in cases where there is varus (bow-legged) or valgus (knock-kneed) deformity, which can contribute to uneven wear on the cartilage and lead to osteoarthritis. By changing the alignment of the tibia, HTO can relieve pressure on the damaged areas of the knee, potentially alleviating pain and improving function.
In your case, since the MRI revealed that your ACL is no longer present and you have developed arthritis and bone spurs, the recommendation for HTO makes sense. This procedure may help to improve the overall alignment of your knee and reduce the symptoms of arthritis. After HTO, if the knee stabilizes and functions better, you may find that you do not need to undergo ACL reconstruction at all. However, if instability persists, a subsequent ACL reconstruction could still be considered.

It's important to note that while HTO can help alleviate symptoms and improve knee function, it does not replace the function of the ACL. The ACL plays a critical role in stabilizing the knee during dynamic activities. If you choose to undergo HTO, your surgeon will likely monitor your knee's stability and function closely to determine if ACL reconstruction is necessary later on.

Ultimately, the decision between these two surgeries should be made in consultation with your orthopedic surgeon, who can provide personalized advice based on your specific knee condition, activity level, and long-term goals. They can help you weigh the benefits and risks of each procedure, considering factors such as your age, activity level, and the extent of joint damage.

In summary, if your primary concern is the instability caused by the absence of the ACL, reconstruction may be necessary. However, if the misalignment and arthritis are significant contributors to your symptoms, HTO may provide a more immediate benefit by addressing those issues first. A comprehensive rehabilitation program following either surgery will be crucial for optimizing recovery and restoring function to your knee.