Description
Medial Opening Wedge high tibial osteotomy (MOWHTO) is a commonly employed surgical procedure among active patients with varus knee. However, MOWHTO is not generally recommended for varus knee patients with lateral femoral condyle (LFC) cartilage injury due to the risk of exacerbation of LFC cartilage injury. This study aims to evaluate the clinical efficacy of MOWHTO combined with osteochondral autologous transplantation (OAT) in cases of bilateral femoral condyles cartilage injury.
Methods: *
Between 2016 and 2021, 30 patients (13 men and 17 women) who underwent OWHTO combined with OAT were retrospectively investigated. OAT was transplanted to the cartilage defect area of LFC. Clinical evaluation including Knee injury and Osteoarthritis Outcome Score (KOOS) was performed preoperatively and at 1 year postoperatively.
To evaluate intraarticular findings, arthroscopic evaluations were assessed preoperatively and 1 year postoperatively.
Cartilage status was graded at the time of initial HTO and second-look arthroscopy according to the International Cartilage Repair Society grading system, and regenerated articular cartilage was classified by ICRS cartilage repair assessment at the time of second-look arthroscopy.
Results: *
The average KOOS subset scores were as follows: KOOS Symptoms, 75.4± 14.9; KOOS Pain, 80.2± 15.3; KOOS Activities of Daily Living, 85.4± 13.9; KOOS Function in Sport and Recreation, 44.6± 25.7 and KOOS Quality of Life, 56.2± 19.5). All scores were significantly increased at 1 year postoperatively (P < 0.001). ICRS grade of LFC (Ⅱ:2 Cases, Ⅲ:20 Cases, Ⅳ:8 Cases) improved (Ⅰ:14 Cases, Ⅱ：1 5cases Ⅳ: 1 case) postoperatively. Twenty-eight cases showed an improvement in ICRS grade over the initial operation, while two cases showed no change; no cases of worsening LFC cartilage injury were observed.
Conclusion: *
Repair of LFC cartilage injury in the varus knee with MOWHTO combined OAT provides good clinical outcomes at 1 year follow-up. Furthermore, this procedure doesn't increase cartilage injury to LFC and could yield desirable results.
