Articular cartilage regeneration of the knee joint after proximal tibial valgus osteotomy: a prospective study of different intra- and extra-articular operative techniques

Abstract

In this prospective study high tibial osteotomy for medial gonarthrosis was performed in 95 patients (105 knee joints). The patients underwent simultaneously diagnostic and operative arthroscopic surgery of the knee joint. A follow-up arthroscopic examination could be performed in 75 patients (85 knee joints) at the time of implant removal. In group 1 (20 knee joints), the osteotomy was performed after diagnostic arthroscopy without arthroscopic operation of the knee joint. The fixation of the osteotomy was accomplished by staples, postoperative plaster fixation and physiotherapy. In group 2 (20 knee joints), osteotomy was performed without additional operative arthroscopy after diagnostic arthroscopy, internal fixation by AOT-plate, no external fixation postoperatively and physiotherapy. In group 3 (22 knee joints), osteotomy was performed with additional operative arthroscopy (Pridie drilling), internal fixation by AOT-plate no external fixation postoperatively no external fixation, physiotherapy and continuous passive motion. In group 4 (23 knee joints), osteotomy was performed with additional operative arthroscopy (abrasio-arthroplasty), internal fixation by AOT-plate, no external fixation postoperatively, physiotherapy and continuous passive motion. All patients underwent arthroscopic examination of the knee with cartilage biopsies taken from three different regions of the femoral condyle during the same operative session as the osteotomy. At follow-up arthroscopy cartilage biopsies were taken from the same regions. There was no great difference in clinical outcome after 1 year between all groups. Arthroscopy as well as routine and electron microscopy showed better cartilage regeneration in groups 3 and 4. Groups 1 and 2 showed only regeneration isles, sometimes not well fixed to the underlying bone, while in groups 3 and 4 cartilage regeneration was thicker and more stable, sometimes covering all of the pre-existing erosions. Therefore, we recommend osteotomy of the tibia for osteoarthritis together with operative arthroscopy in the same operative session.

The Use of Arthroscopy in the Athlete with Knee Osteoarthritis

“…However, there were no differences in clinical outcome between groups. Schultz et al reported similar finding in a retrospective comparison of diagnostic arthroscopy, drilling, and abrasion arthroplasty in conjunction with HTO [79]. No difference in clinical outcome was found at 1-year follow-up.…”

“…Adequate valgus correction was the primary determinant of outcome in both studies. Other authors recommend routine arthroscopy before HTO [79,80]. They stress the low morbidity of the procedure and the ability to treat concomitant intraarticular pathology.…”

“…Arthroscopic debridement, drilling, and abrasion arthroplasty have been combined with HTO [79,81]. One prospective, nonrandomized, comparison trial has been performed [81].…”

Short-Term Effects of Different Arthroscopic Techniques in the Treatment of Chondral Defects (Shaving, Coblation, and Microfacturing)

“…Since the differences between mechanical shaving, bipolar chondral coblation and microfracturing are neg- [20]. In older patients, however, methods not requiring with long rehabilitation periods should be used.…”

Combined Biplanar High Tibial Osteotomy, Anterior Cruciate Ligament Reconstruction, and Abrasion/Microfracture in Severe Medial Osteoarthritis of Unstable Varus Knees

“…11,12 Stability of the knee and the absence or correction of malalignment are preconditions for all types of cartilage procedures. [13][14][15] Apart from deformity correction in the coronal plane, osteotomies can strongly influence the sagittal plane by consciously or unconsciously altering the tibial slope. [16][17][18][19] Although being well accepted in the treatment of posterior and posterolateral instabilities, the role of slope modifications in ACL-deficient knees is still not well understood.…”