The role of microfractures with tibial osteotomy in the treatment of knee osteoarthritis with a varus deformity

Abstract

ObjectiveTo evaluate the microfracture intervention with tibial valgus osteotomy associated in the treatment of varus gonarthrosis.MethodsFrom November 2005 to May 2013, 129 patients with medial gonarthrosis, varus deformity (8°–12°), and range of movement greater than 90° were evaluated. Patients with advanced gonarthrosis (Alhbäck 3, 4, and 5), Outerbridge lesion inferior to IV, previous knee surgery, body mass index greater than 35 kg/m2, and/or cruciate ligament injuries were not included. All patients were treated with videoarthroscopy followed by tibial valgus osteotomy. In the group osteotomy associated with microfracture (n = 56, mean age = 39.3), tibial valgus osteotomy and microfracture techniques to address chondral defects were used. In the isolated osteotomy group (n = 73, mean age = 41.4), only this procedure was performed. Post-surgical follow-up was 24 months, with four evaluations in the first 6 months, proceeding to biannual twice-a-year evaluation in the subsequent period. The Lysholm scale was used for functional monitoring.ResultsThere was a significant improvement in the pain, limping, and squatting domains of the Lysholm scale but only in the isolated osteotomy group. A greater variance of results was observed in the osteotomy group associated to microfracture, in addition to an increased risk of functional deterioration (OR = 8.64).ConclusionThe association of microfractures and tibial valgus osteotomy was correlated to lower functional outcomes than tibial valgus osteotomy alone, and may be related to the risk of worsening in the first two postoperative years.

Biological intra‐articular augmentation for osteotomy in knee osteoarthritis: strategies and results

“…On the other hand, two of the five studies comparing osteotomy alone vs osteotomy and MF reported worse clinical results in the augmentation group [15, 65]. All but one [65] study performed further evaluations other than the clinical assessment. Seven studies evaluated the cartilage macroscopic status arthroscopically [1, 30, 36, 44, 49, 59, 70], five with histological assessment [1, 36, 49, 59, 70], and eight performed an imaging evaluation, three with MRI [36, 44, 53] and six with radiographs [15, 30, 44, 49, 59, 68].…”

“…The degree of OA ranged from Kellgren–Lawrence (KL) II to KL IV and Ahlbäck I–III, and it was not specified in 19 studies. Among the cartilage surgical treatments, the most used was the microfracture technique (MF, 17 studies) [15, 28, 35, 36, 43, 44, 49, 50, 53, 60‐62, 65‐68, 73], followed by abrasion arthroplasty (AA, 5 studies) [1, 49, 59‐61], umbilical cord mesenchymal stem cells implantation (UCB‐MSCs, 5 studies) [11, 43, 64, 68, 72], and autologous chondrocyte implantation (ACI, 4 studies) [4, 8, 15, 35], while other techniques were reported only in a few studies (Table 1). Most studies reported follow‐up from 12 to 36 months.…”

“…Out of the 11 evaluated comparative studies with surgical augmentation, only the comparative non‐RCT of Suh et al [68] demonstrated a significant clinical benefit of the augmentation procedure, reporting better IKDC subjective scores in the drilling + hUCB‐MSCs group than in the MF group. On the other hand, two of the five studies comparing osteotomy alone vs osteotomy and MF reported worse clinical results in the augmentation group [15, 65]. All but one [65] study performed further evaluations other than the clinical assessment.…”

Effect of the amount of correction on posterior tibial slope and patellar height in open-wedge high tibial osteotomy

“…1 Many favorable results for OWHTO have recently been reported. [2][3][4] The main aim of OWHTO is redistribution of load from the medial compartment to the central and lateral areas by correcting the varus deformity of the knee. 5,6 Thus, the pressure in medial compartment is decompressed, resulting in pain relieving and delaying of cartilage damage, even partial cartilage regeneration can be observed.…”