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Medial open-wedge high tibial osteotomy linked with cartilage regeneration
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While correcting a varus deformity in arthritic knees after medial open-wedge high tibial osteotomy with a locked plate system and no additional cartilage regeneration procedures, researchers noted that regeneration of degenerated articular cartilage in the medial compartment can be expected.
Researchers identified 104 knees that received medial open-wedge high tibial osteotomy (HTO) with a medial locked plate system without any additional cartilage regeneration procedures and followed by second-look arthroscopy for plate removal 2 years after surgery from February 2008 to January 2014. Using the International Cartilage Repair Society grading system, researchers graded cartilage status at the time of initial HTO and second-look arthroscopy. The macroscopic staging system of Koshino and colleagues was used to classify regenerated articular cartilage at the time of second-look arthroscopy. Researchers evaluated patient age, sex, BMI, American Knee Society score, mechanical tibiofemoral angle, medial proximal tibial angle, the amount of correction angle and the degree of arthritis for possible association with regeneration of articular cartilage.
Results showed that at the time of second-look arthroscopy 51.9% of knees had improved lesions in the medial femoral condyle and 34.6% of knees had improved lesions in the medial tibial plateau, based on the ICRS grading system. Researchers observed partial and total regeneration of articular cartilage in the medial femoral condyle and the medial tibial plateau in 72% and 55% of knees, respectively, according to the macroscopic grading system.
Univariate logistic regression tests showed an association between regeneration of articular cartilage with a smaller mean preoperative varus mechanical tibiofemoral angle and lower BMI for the medial femoral condyle. For the medial tibial plateau, researchers found an association between regeneration of articular cartilage with younger age and a larger mean correction angle. At last follow-up, results showed a significant improvement from mean preoperative knee and function scores. However, researchers found no correlation between clinical outcomes and cartilage regeneration. Lower BMI was a significant predictor for the medial femoral condyle, according to multiple logistic regression analysis for regeneration of articular cartilage. – by Casey Tingle
Disclosures: The researchers report no relevant financial disclosures.
Perspective
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Jean-Noel A. Argenson, MD, PhD
In their study, Kim and colleagues evaluated the cartilage regeneration in the previously degenerated medial compartment of arthritic knees after medial open wedge HTO by performing second-look arthroscopy for plate removal 2 years after surgery. They retrospectively evaluated 104 consecutive knees operated with medial open-wedge HTO fixed with a medial locked plate system without any additional cartilage regeneration procedures in patients with a mean age of 56 years. They found the lesions in the medial femoral condyle and the medial tibial plateau were improved respectively in 54 knees (51.9%) and 36 knees (34.6%) using the ICRS grading system and the regeneration of articular cartilage improved, respectively, in 75 knees (72%) and 57 knees (55%) using the macroscopic staging system of Koshino. The knee and function scores were significantly improved at the last follow-up, but no correlation was found between the clinical outcomes and cartilage regeneration. In this study the positive predictive factors influencing cartilage regeneration after HTO were smaller mean preoperative varus mechanical tibiofemoral angle, lower BMI and a larger mean correction angle for the medial tibial plateau. Lower BMI was found to be a significant predictor for the medial femoral condyle.
Despite limitations due to a short follow-up at 2 years for a reconstructive procedure and the absence of recommendation findings regarding age, sex or arthritis degree, which may influence the results in some series, the second-look arthroscopy performed in a systematic manner in the present study on all 104 knees was able to confirm the efficacy of medial open-wedge osteotomy for cartilage regeneration of varus knees, especially in patients with lower BMI.
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