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<p>Coronal malalignment has been shown to increase the load on the anterior cruciate ligament (ACL) and may negatively affect outcomes following ligament reconstruction. Clinically, acute primary tears must be distinguished from chronic ACL insufficiency, which frequently occurs in combination with medial compartment osteoarthritis. In acute primary tears, isolated ACL reconstruction is the treatment of choice. For chronic cases, classification into primary, double, and triple varus deformities may guide treatment indication. In patients presenting with coronal malalignment and concomitant ligamentous instability, treatment options include isolated ligament reconstruction, isolated realignment osteotomy, or combined procedures, which may be performed either as a&#xa0;single-stage or staged approach. The choice of treatment should be based on the clinical presentation and overall symptoms. The tibial slope should be incorporated into the indication assessment and, if necessary, corrected concomitantly during a&#xa0;medial opening wedge high tibial osteotomy.</p>

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Koronares Malalignment bei Insuffizienz des vorderen Kreuzbandes: Wann Bandersatz, wann Achskorrektur, wann beides?

  • 期刊论文

  • 发表日期：

    2026年7月14日

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  • Ben L. Wagener,
  • Peter Angele,
  • Julian Fürmetz,
  • Julius Watrinet

摘要

Coronal malalignment has been shown to increase the load on the anterior cruciate ligament (ACL) and may negatively affect outcomes following ligament reconstruction. Clinically, acute primary tears must be distinguished from chronic ACL insufficiency, which frequently occurs in combination with medial compartment osteoarthritis. In acute primary tears, isolated ACL reconstruction is the treatment of choice. For chronic cases, classification into primary, double, and triple varus deformities may guide treatment indication. In patients presenting with coronal malalignment and concomitant ligamentous instability, treatment options include isolated ligament reconstruction, isolated realignment osteotomy, or combined procedures, which may be performed either as a single-stage or staged approach. The choice of treatment should be based on the clinical presentation and overall symptoms. The tibial slope should be incorporated into the indication assessment and, if necessary, corrected concomitantly during a medial opening wedge high tibial osteotomy.