Role of High Tibial Osteotomy in Cartilage Regeneration – Is Correction of Malalignment Mandatory for Success?

Abstract

Malalignment of the knee can cause debilitating symptoms such as pain, resulting in a decline in function and mobility. Surgical options that exist to address this problem include realignment osteotomies and joint replacements. Realignment osteotomies are the more appropriate options in certain patient populations, especially with regard to age and level of activity. Since a high tibial osteotomy (HTO) was first used to manage malalignment of the knee and osteoarthritis, different techniques involving the use of specialized implants have been developed and further refined to good effect. There has also since been much research into the field of cartilage restoration techniques, both as a standalone treatment option and as an adjunct to a realignment osteotomy. This review attempts to detail the origin and the evolution of HTO, particularly in regard to combining this tried and tested procedure with adjunct cartilage restoration techniques, and the overall patient outcomes. A literature search on PubMed was performed, and articles pertaining to the outcomes of the use of an HTO and cartilage restoration techniques were reviewed. The literature in this field indicates good outcomes in terms of objective measurements of cartilage regeneration (such as arthroscopic visualization and magnetic resonance imaging evaluation) and subjective patient outcome scoring systems (such as the International Knee Documentation Committee and Lysholm scores) with a realignment osteotomy alone, and studies have shown that patient outcomes can be further improved with the use of a cartilage restoration procedure as an adjunct.

Changes in Cartilage Thickness and Denuded Bone Area after Knee Joint Distraction and High Tibial Osteotomy—Post-Hoc Analyses of Two Randomized Controlled Trials

“…The results for HTO patients contradict those found in literature, in which quantitative cartilage restoration was seen, although most studies used second-look arthroscopy to visually score cartilage restoration after HTO, and discrepancies may be expected between such different scoring/measurement methods [ 38 ]. Two studies have suggested that cartilage gain occurs after HTO using the same MRI measurement method as used in the current study, although in both cases the increases were not statistically significant [ 39 , 40 ].…”

Diz çevresi osteotomilerinin kıkırdak basıncı ve rejenerasyonu üzerine etkileri

“…[17] Osteotomi ile birlikte mozaikplasti uygulamasının özellikle ikinci bakış artroskopisi ile değerlendirilmesi literatürde çok yer bulmamıştır ve bu kombine işlemin objektif etkilerinin değerlendirilebilmesi için yeni çalışmalara gereksinim olduğu gözlenmektedir. [5] Otolog kondrosit implantasyonu defekt alanının cm 2 'nin altında olduğu, 30 yaşından genç hastalarda ve dizilim düzeltici osteotomi ile birlikte uygulandığında daha iyi sonuç vermektedir. [28] Kim ve ark.…”

“…[4] Özellikle genç, aktif, eklem hareket açıklığı geniş, bağ laksitesi olmayan izole medial osteoartritli hastalarda medial açık kama osteotomisi iyi sonuç veren ve komplikasyonu daha az bir cerrahi yöntemdir. [4][5][6] Tek kompartman artrozu olan hastalarda dizilimi düzelten osteotomi tek başına yapılabileceği gibi, abrazyon, subkondral drilleme veya mikrokırık, otolog kondrosit implantasyonu, mozaikplasti, trombositten zengin plazma ve kök hücre tedavileri gibi kıkırdak restorasyonunu amaçlayan işlemler birlikte de yapılabilir. Diğer taraftan bakıldığında da, kıkırdak yenileyici bir işlem yapılması planlanan hastalarda eğer dizilim bozukluğu varsa düzeltici osteotomi de eklenmelidir.…”

Isolation and characterization of mesenchymal stem cells in orthopaedics and the emergence of compact bone mesenchymal stem cells as a promising surgical adjunct

“…The use of MSCs for regeneration of the musculoskeletal system is an area of much basic science research and evolving clinical applications[ 51 - 54 ]. Over the past twenty years, MSCs have been used clinically in a variety of scenarios to enhance the outcome for orthopedic patients from the standpoint of both wound healing and pain[ 55 ]. Dating back to the 1980s, bone grafting and bone marrow injection into fracture sites has been utilized to enhance union[ 4 ].…”

“…Fifty-three of the 60 patients went on to union at an average of twelve week[ 56 ]. Clinical applications of MSCs have since expanded to include healing of high-tibial osteotomies, large bone defects after total hip arthroplasty and trauma, distraction osteogenesis, treatment of avascular necrosis, articular cartilage defects, tendinopathy (patellar, lateral epicondylitis), spinal fusion, and treatment of bone cysts[ 2 , 4 , 31 , 55 , 57 - 60 ]. These findings paved the way for future use and investigations to understand the mechanisms underlying the observed wound healing effects.…”