Abstract
BackgroundIt is unclear whether postoperative outcomes are associated with the cartilage regeneration after open wedge high tibial osteotomy (OWHTO) combined with microfracture. The purpose of this study was to evaluate the regeneration of the articular cartilage, radiologic, and clinical outcomes after OWHTO with and without microfracture.MethodsEighty-seven patients who underwent OWHTO from 2014 to 2015 were retrospectively included in this study. Fifty-seven OWHTOs with microfracture on medial femoral condyle (MFC) (group 1) and 30 OWHTOs without microfracture (group 2) were compared at a mean 2-year follow-up. The regeneration of the articular cartilage was evaluated using International Cartilage Repair Society (ICRS) grade on the second-look arthroscopy and the magnetic resonance observation of cartilage repair tissue (MOCART) score on magnetic resonance imaging (MRI). The weight-bearing line (WBL) ratio, hip-knee-ankle (HKA) angle, joint line convergence angle (JLCA) and Ahlbäck grade were evaluated. The clinical outcomes were evaluated using the Western Ontario and McMaster University (WOMAC) scores and the Knee Society (KS).ResultsThe articular cartilage in the MFC were regenerated in 67.8% of group 1 (43/57) and 58.6% of group 2 (16/30), respectively (p = 0.014). However, change of the ICRS grades of the medial tibial plateau, lateral and patellofemoral compartments showed no statistical difference between the groups. Total MOCART score in group 1 was superior to that in the group 2 at postoperative 2 years (41.8 ± 18.6 vs. 31.8 ± 19.8, p = 0.023). Regarding MOCART score, microfracture was only effective in the defect filling and integration to the border zone of the MFC (p < 0.001 and p = 0.035, respectively). Other radiologic and clinical outcomes showed no statistical differences between the groups.ConclusionMicrofracture of the MFC during OWHTO only helped the filling of the degenerative cartilage defect and the integration of the cartilage with adjacent cartilage. However, the clinical and radiologic outcome could not be improved by mircrofracture in the OWHTO.
Highlights
It is unclear whether postoperative outcomes are associated with the cartilage regeneration after open wedge high tibial osteotomy (OWHTO) combined with microfracture
Among a total of 87 patients included in this study, 57 patients were included in group 1 and 30 OWHTOs were included in group 2, with a mean follow-up of two years
The improvement of International Cartilage Repair Society (ICRS) grade of medial femoral condyle (MFC) was observed in 75.4% (43/57) among the patients of group 1, whereas 53.3% (16/30) among the patients of group 2 showed the improvement of ICRS grade of MFC (p = 0.014)
Summary
It is unclear whether postoperative outcomes are associated with the cartilage regeneration after open wedge high tibial osteotomy (OWHTO) combined with microfracture. Open wedge (OW) high tibial osteotomy (HTO) is an effective surgical treatment for patients with medial compartmental osteoarthritis combined with varus alignment [1,2,3,4]. Several studies have suggested that OW HTO combined with cartilage repair techniques such as microfracture, subchondral drilling, abrasion arthroplasty, and autologous chondrocyte implantation might enable more effective cartilage regeneration and improved long-term outcomes [12,13,14,15]. The cartilage defects are filled with precursor cells, resulting in a new cartilage and regenerative tissue [14] It is unclear whether postoperative clinical outcomes are associated with the quality of cartilage regeneration after OW HTO combined with microfracture. Little is known about the factors that influence clinical outcomes after OW HTO
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