Do Microfractures Improve High Tibial Osteotomy Outcome?

Abstract

The aim of this study was to determine if microfractures improve the outcome of high tibial osteotomy in patients with medial compartmental osteoarthritis in genu varum. Forty patients presenting with Outerbridge grade III and IV chondropathies on the femoral and/or the tibial joint surface underwent high tibial osteotomy with Puddu plates (Arthrex, Inc, Naples, Florida) for primary medial compartment osteoarthritis in genu varum at our institution. Patients were randomly assigned to either the high tibial osteotomy plus microfractures group (A; n=20) or the high tibial osteotomy alone group (B; n=20). Final assessment was conducted 5 years postoperatively, including clinical response measured by the International Knee Documentation Committee (IKDC), Lysholm score, and patient satisfaction score. All patients were blinded to the treatment received and followed the same rehabilitation protocol. A statistically significant improvement between pre- and postoperative values was observed for Lysholm and IKDC scores in both groups, without any statistically significant difference between them. Regarding the satisfaction score, there were no differences between the 2 groups in terms of preoperative self-assessment (P>.05), whereas postoperative subjective satisfaction at 5-year follow-up was significantly higher in group A than in group B (P=.0036).Our study results provide further evidence that medial tibial osteotomy is an effective surgical option for treating a varus knee associated with medial degenerative arthritis in patients wishing to continue accustomed levels of physical activity. In particular, patient satisfaction was higher among those who underwent the combined treatment involving high tibial osteotomy to correct femorotibial angle and microfractures.

Joint Preservation Surgery for Medial Compartment Osteoarthritis

“…5 However, the role of additional cartilage surgeries in better survival and higher clinical scores cannot be ruled out. 6,7 For any joint preservation surgery to be successful, a cartilage surgeon must select the "best of two worlds" and perform both the procedures as a single-stage procedure.…”

“…3 However, combining the principles of biomechanical correction along with the cartilage repairs has also given encouraging results with a longer duration of follow-up and better clinical scores. [4][5][6][7] Somewhere, it is the synergistic role of both the principles that leads to a better outcome with the combined procedure.…”

Management of Knee Articular Cartilage Injuries

“…Both CW-HTO and OW-HTO techniques have seen similar success concurrent with microfracture (Sterett and Steadman 2004;Sterett, Steadman et al 2010;Pascale, Luraghi et al 2011), abrasion arthroplasty (Matsunaga, Akizuki et al 2007), and ACI (Franceschi, Longo et al 2008;Gomoll, Kang et al 2009;). …”

Success of High Tibial Osteotomy in the United States Military

“…Functional reports of HTO in young, athletic patient populations are also limited, 3,14 particularly when combined with other intra-articular knee procedures. 2,10,16,19,21,31 To this end, the current investigation reports on the clinical, functional, and occupational outcomes of 181 physically active military service members undergoing HTO with 2-to 8-year follow-up. Of this cohort, 72% of patients returned to military duty without secondary conversion to knee arthroplasty.…”