Masatake MatsuokA1, Eiji Kondo2, Koji Iwasaki3, Tomohiro Onodera1, Ryuichi Nakamura4, Hiroshi Nakayama5, Takenori Akiyama6, Daisuke Momma2, Norimasa Iwasaki1

1Department of Orthopaedic Surgery, Hokkaido University, Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan
2Hokkaido University Hospital, Centre for Sports Medicine, Sapporo, Japan
3Department of Functional Reconstruction for the Knee Joint, Hokkaido University, Faculty of Medicine, Sapporo, Japan
4Harue Hospital, Joint Preservation and Sports Orthopaedic Center, Sakai, Japan
5Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
6Department of Orthopaedic Surgery, Akiyama Clinic, Fukuoka, Japan

Keywords: Anterior cruciate ligament, distal femoral varus osteotomy, doublebundle reconstruction, elderly, osteoarthritis, orthopedics, valgus knee.


Distal femoral varus osteotomy (DFVO) is a widely recognized surgical procedure used to address valgus malalignment in patients with knee joint disorders. However, it still remains unclear whether anterior cruciate ligament (ACL) reconstruction can be performed in a single procedure along with DFVO. Herein, we present a 73-year-old female patient who developed lateral osteoarthritis of the knee with valgus alignment due to chronic ACL deficiency following a twisting injury during skiing. She was physiologically very active, and strongly demanded to return to sports. We performed a combined procedure involving a medial closing wedge DFVO using an anatomical locking plate, along with double-bundle ACL reconstruction. The postoperative radiograph confirmed successful correction of knee alignment, specifically achieving varus alignment with precise conformance of the anatomical plate to the medial contour of the distal femur following the osteotomy. The patient resumed her previous sports activities without experiencing knee pain. The operated knee demonstrated restored anterior stability, as indicated by negative Lachman test results, and regained full range of motion. Both the Knee Injury and Osteoarthritis Outcome Score and the 2011 Knee Society score demonstrated continuous postoperative improvements over the three-year follow-up period, indicating positive functional outcomes and joint preservation. To the best of our knowledge, this is the first case of medial closing wedge DFVO with anatomic double-bundle ACL reconstruction in the symptomatic femoral valgus deformity with chronic ACL deficiency in the literature.

Citation: Matsuoka M, Kondo E, Iwasaki K, Onodera T, Nakamura R, Nakayama H, et al. Simultaneous medial closing wedge distal femoral varus osteotomy and double-bundle anterior cruciate ligament reconstruction in the symptomatic femoral valgus deformity: A case report.. Jt Dis Relat Surg 2024;35(2):422-432. doi: 10.52312/jdrs.2024.1176.

Author Contributions

Idea/concept, design: E.K., R.N., H.N., T.A.; Control/supervision: M.M., E.K., K.I., N.I.; Data collection and/or processing: M.M., E.K.; Literature review: K.I., T.O., D.M.; Writing the article: M.M., E.K., R.N., H.N., T.A.; Critical review: T.O., N.I.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.