Cartilage repair procedures associated with high tibial osteotomy in varus knees: Clinical results at 11years' follow-up

Ferruzzi, A.; Buda, Roberto; Cavallo, Marco; Timoncini, Antonio; Natali, Simone; Giannini, Sandro

doi:10.1016/j.knee.2013.11.013

Cited by 68 publications

(87 citation statements)

References 33 publications

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“…A total of 128 patients from two studies involving three comparisons reported the results of radiographic signs of OA, and they were reported as Kellgren and Lawrence (KL) scale. 10,27 The heterogeneity among the involved studies was low (p ¼ 0.29, I 2 ¼ 20%) and the fixed effects model was used. The pooled results indicated that there was no significant difference between experimental and control group (MD ¼ 0.02, 95% CI ¼ À0.01 to 0.06, p ¼ 0.24, ►Fig.…”

Section: Radiographic Resultsmentioning

confidence: 99%

“…The preliminary literature search yielded 2,413 potentially relevant records, after removing the duplicates and screening the titles, abstracts, and full texts, finally six RCTs 5,[22][23][24][25][26] and nine cohorts 4,6,10,11,16,[27][28][29][30] with a total of 834 patients were involved in our analysis. The reviewers reached an agreement for study selection by discussion.…”

Section: Literature Searchmentioning

confidence: 99%

“…6 Although several studies reported cartilage regeneration after HTO alone, [7][8][9] long-term series showed a clinical and radiological deterioration over time. 10 To improve the longterm outcomes many cartilage repair procedures appeared, such as microfractures (MFs) and autologous chondrocyte implantation (ACI). 11 Some researcher reported that cartilage repair procedures had a significant effect on cartilage regeneration and improved clinical outcomes obviously, [12][13][14][15] while some authors reported that the procedures have little beneficial effect on cartilage regeneration or clinical outcomes, 16,17 even had an opposite effect.…”

mentioning

confidence: 99%

“…11 Some researcher reported that cartilage repair procedures had a significant effect on cartilage regeneration and improved clinical outcomes obviously, [12][13][14][15] while some authors reported that the procedures have little beneficial effect on cartilage regeneration or clinical outcomes, 16,17 even had an opposite effect. 10 Therefore, whether we should perform cartilage repair procedures during HTO for osteoarthritic knee is controversial.…”

mentioning

confidence: 99%

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Effectiveness of High Tibial Osteotomy with or without Other Procedures for Medial Compartment Osteoarthritis of Knee: An Update Meta-Analysis

Yao

Liu

et al. 2020

J Knee Surg

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To improve the long-term outcomes of high tibial osteotomy (HTO) for gonarthritis, many cartilage repair procedures appeared, but their effects were controversial. To evaluate the efficacy of cartilage repair procedures during HTO for gonarthritis, we performed this update meta-analysis. We performed the system retrieval for clinical trials using various databases and then pooled the outcomes of the included studies. Fifteen studies were involved. The pooled results indicated that there were no significant differences in Kellgren and Lawrence (KL) scale (mean difference [MD] = 0.02, 95% confidence interval [CI] = −0.01 to 0.06, p = 0.24), the femorotibial angle (MD = 0.06, 95% CI = −0.04 to 0.16, p = 0.22), and magnetic resonance imaging (MRI) outcomes (MD = 12.53, 95% CI = −2.26 to 27.32, p = 0.10) of patients in experimental group than control. The subgroup analysis showed that the clinical outcomes of abrasion arthroplasty (AA) were worse than control group (standardized mean difference [SMD] −2.65, 95% CI = −3.67 to −1.63, p < 0.001), while mesenchymal stem cells (MSCs) injection improved the clinical outcomes (SMD = 2.37, 95% CI = 1.25–3.50, p < 0.001). There were significant differences between the two groups in arthroscopic (SMD = 1.38, 95% CI = 0.82–1.94, p < 0.001) and histologic results (relative risk [RR] = 1.77, 95% CI = 1.36–2.29, p < 0.001). The pain relief (MD = 0.17, 95% CI = −3.26 to 3.61, p = 0.92) and operative complications (RR = 1.42, 95% CI = 0.83–2.42; p = 0.19) of the two groups had no significant differences. Our analysis supports that concurrent cartilage repair procedures might improve arthroscopic and histologic outcomes, but they have no beneficial effect on clinical outcomes, radiograph, MRI, and pain relief. The concurrent procedures do not increase the risk of operative complication. Furthermore, MSC has some beneficial effects on clinical outcomes, while AA might play an opposite role.

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Section: Radiographic Resultsmentioning

confidence: 99%

Section: Literature Searchmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Effectiveness of High Tibial Osteotomy with or without Other Procedures for Medial Compartment Osteoarthritis of Knee: An Update Meta-Analysis

Yao

Liu

et al. 2020

J Knee Surg

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“…Cartilage lesions in these patients are characterized not only by existing biomechanical problems but also by occasionally severe biochemical changes that may negatively influence the cartilage repair (Ferruzzi et al. 2014). The use of such methods in joints with more severe OA is, however, rare.…”

Section: Methodsmentioning

confidence: 99%

Cartilage repair in the degenerative ageing knee

et al. 2016

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Background and purposeCartilage damage can develop due to trauma, resulting in focal chondral or osteochondral defects, or as more diffuse loss of cartilage in a generalized organ disease such as osteoarthritis. A loss of cartilage function and quality is also seen with increasing age. There is a spectrum of diseases ranging from focal cartilage defects with healthy surrounding cartilage to focal lesions in degenerative cartilage, to multiple and diffuse lesions in osteoarthritic cartilage. At the recent Aarhus Regenerative Orthopaedics Symposium (AROS) 2015, regenerative challenges in an ageing population were discussed by clinicians and basic scientists. A group of clinicians was given the task of discussing the role of tissue engineering in the treatment of degenerative cartilage lesions in ageing patients. We present the outcomes of our discussions on current treatment options for such lesions, with particular emphasis on different biological repair techniques and their supporting level of evidence.Results and interpretationBased on the studies on treatment of degenerative lesions and early OA, there is low-level evidence to suggest that cartilage repair is a possible treatment for such lesions, but there are conflicting results regarding the effect of advanced age on the outcome. We concluded that further improvements are needed for direct repair of focal, purely traumatic defects before we can routinely use such repair techniques for the more challenging degenerative lesions. Furthermore, we need to identify trigger mechanisms that start generalized loss of cartilage matrix, and induce subchondral bone changes and concomitant synovial pathology, to maximize our treatment methods for biological repair in degenerative ageing joints.

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