Second-look arthroscopic cartilage status is related to intermediate-term outcomes after medial opening-wedge high tibial osteotomy

Abstract

Aims To determine the relationship between articular cartilage status and clinical outcomes after medial opening-wedge high tibial osteotomy (MOHTO) for medial compartmental knee osteoarthritis at intermediate follow-up. Methods We reviewed 155 patients (155 knees) who underwent MOHTO from January 2008 to December 2016 followed by second-look arthroscopy with a mean 5.3-year follow-up (2.0 to 11.7). Arthroscopic findings were assessed according to the International Cartilage Repair Society (ICRS) Cartilage Repair Assessment (CRA) grading system. Patients were divided into two groups based on the presence of normal or nearly normal quality cartilage in the medial femoral condyle: good (second-look arthroscopic) status (ICRS grade I or II; n = 70), and poor (second-look arthroscopic) status (ICRS grade III or IV; n = 85) groups at the time of second-look arthroscopy. Clinical outcomes were assessed using the International Knee Documentation Committee (IKDC) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 36-Item Short Form survey. Results Significant improvements in all clinical outcome categories were found between the preoperative and second-look arthroscopic assessments in both groups (p < 0.001). At the latest follow-up, the mean IKDC and WOMAC scores in the good status group further improved compared with those at the time of second-look arthroscopic surgery (p < 0.001), which was not shown in the poor status group. The mean IKDC (good status, 72.8 (SD 12.5); poor status, 64.7 (SD 12.1); p = 0.002) and mean WOMAC scores (good status, 15.7 (SD 10.8); poor status, 21.8 (SD 13.6); p = 0.004) significantly differed between both groups at the latest follow-up. Moreover, significant correlations were observed between ICRS CRA grades and IKDC scores (negative correlation; p < 0.001) and WOMAC scores (positive correlation; p < 0.001) at the latest follow-up. Good cartilage status was found more frequently in knees with the desired range of 2° to 6° valgus correction than in those with corrections outside this range (p = 0.019). Conclusion Second-look arthroscopic cartilage status correlated with clinical outcomes after MOHTO at intermediate-term follow-up, despite the relatively small clinical differences between groups. Cite this article: Bone Joint J 2021;103-B(11):1686–1694.

Avoiding Overcorrection to Increase Patient Satisfaction After Open Wedge High Tibial Osteotomy

“…Numerous studies have reported that OWHTO showed excellent clinical outcomes, slowed osteoarthritis progression, and delayed subsequent knee arthroplasty. 6,14,24,33,34…”

“…Numerous studies have reported that OWHTO showed excellent clinical outcomes, slowed osteoarthritis progression, and delayed subsequent knee arthroplasty. 6,14,24,33,34 Conventionally, the target of adjusting the mechanical axis of the lower extremity is to pass through 62% to 62.5% from the medial edge of the proximal tibia, and previous studies reported favorable clinical outcomes and regeneration of articular cartilage of the medial femoral condyle after OWHTO targeting this point. 7,15,17 Despite accurate preoperative planning and fine surgical techniques, many OWHTOs result in under-or overcorrected alignment of the lower extremity as compared with the target point.…”

Cartilage regeneration is related to superior mid‐term patient‐reported outcomes after open‐wedge high tibial osteotomy

“…Cartilage improvement after open-wedge high tibial osteotomy (OWHTO) is affected by age, sex, body mass index (BMI), preoperative cartilage status and postoperative limb alignment [1,8,11,13,16,24,26,33,34]. However the association between cartilage improvement after OWHTO and pain as well as knee function remains controversial [1,26], especially concerning medium-and long-term outcomes.…”

Impact of the Weightbearing Line on Cartilage Regeneration of the Medial Knee Compartment after Open-Wedge High Tibial Osteotomy, Based on Second-Look Arthroscopy

“… 1 , 2 OWHTO improves the biomechanical environment of the knee joint by correcting the abnormal lower limb alignment with cartilage regeneration to produce the associated clinical outcomes and promote patient satisfaction. 3 - 7 Cartilage regeneration after high tibial osteotomy is influenced by multiple factors, including age, sex, body mass index (BMI), and postoperative knee alignment. 4 It should be noted, however, that the status of the articular cartilage at the time of second-look arthroscopy has not always been considered a predictor of clinical outcomes.…”