Factors affecting cartilage repair after medial opening-wedge high tibial osteotomy

Kumagai, Ken; Akamatsu, Yasushi; Kobayashi, Hideo; Kusayama, Yoshihiro; Koshino, Tomihisa; Saito, T.

doi:10.1007/s00167-016-4096-z

Cited by 70 publications

(54 citation statements)

References 29 publications

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“…[13], we could not find any effect of BMI on cartilage regeneration, contrary to Kumagai et al [11] and Kim et al [12]. The relatively low BMI of our study sample might have been the reason why there was no association with cartilage regeneration.…”

Section: Discussioncontrasting

confidence: 89%

“…Moreover, when the kissing lesions is present, it can possibly affect cartilage regeneration by disturbing the stable position of marrow stem cells during the regeneration process. Like in our study, most investigations assessing cartilage regeneration have shown that a larger cartilage defect is associated with poor cartilage regeneration [11,13,24].…”

Section: Discussionsupporting

confidence: 76%

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Risk factors of cartilage regeneration in patients who underwent high tibial osteotomy combined with microfracture

Ingle¹,

Song

Cho

et al. 2019

Preprint

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Background: One of the option for treating unicompartmental osteoarthritis (OA) is high tibial osteotomy (HTO). HTO which can shift the mechanical axis to the lateral compartment, can performed with microfracture which provides cells capable of producing cartilage. And this procedure is one of the common combinations that orthopaedic surgeons are in practice recently. The purpose of this study was to evaluate the degree of regeneration of cartilage after performing microfracture (MF) with high tibial osteotomy (HTO) after 2- year follow up and identify the factors influencing the regeneration of cartilage after the procedure. We also evaluated whether the regenerated cartilage status affects clinical outcomes. Methods: A total of 81 cases that underwent second-look arthroscopy at the time of plate removal after MF and HTO with a minimum two-year follow-up were included. The patients were divided into two groups according to femoral cartilage regeneration. Multivariable logistic regression analyses were performend to identify independent factors that influence cartilage regeneration. We also compared differences in functional outcomes between the two groups. Results: On the femoral side, grade I cartilage regeneration was found in seven (8.6%), grade II in 19 (23.5%), grade III in 26 (32.1%), and grade IV in 29 cases (35.8%), resulting in 26 (32.1%) patients belonging to well regenerated group (group A) and 55 (67.9%) to the poorly regenerated group (group B). Among factors, the size of the cartilage lesion (P=.011) and the presence of kissing lesions (P=.027) significantly affected cartilage regeneration. There were no statistically significant differences between group A and group B in terms of KSS and WOMAC scores. Conclusions: A large cartilage defect and the presence of kissing lesions are associated with poor cartilage regeneration after combined MF and HTO surgery. However, the quality of regenerated cartilage does not affect functional outcomes in patients with MF and HTO. Keywords: High tibial osteotomy, Microfracture, Second-look arthroscopy, Cartilage regeneration, risk factor

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Section: Discussioncontrasting

confidence: 89%

Section: Discussionsupporting

confidence: 76%

Risk factors of cartilage regeneration in patients who underwent high tibial osteotomy combined with microfracture

Ingle¹,

Song

Cho

et al. 2019

Preprint

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“…Kumagai et al [15] reported Body Mass Index(BMI), initial cartilage and postoperative limb alignment were major factors on HTO. Age, gender and clinical results were not affect the cartilage regeneration.…”

Section: Discussionmentioning

confidence: 99%

İs Combined Acellular Collagen Matrix and High Tibial Osteotomy Treatment Effective In Osteochondral Defects? Preliminary Study

Konya¹,

Horata

Maralcan

et al. 2017

Acta Medica Alanya

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Aim:In this study, we want to compare clinical and radiological results of 12 patient treated with acellular collagen matrix (ACM) and High Tibial osteotomy-cellular collagen matrix(ACM-HTO) combination. Method:In this study, we evaluated 12 patients with chondral lesion prospectively the years of between 2014-2016 after ethical approval. Cartilage damage was diagnosed with MRI and cartilage degeneration volume was calculated with Mimics medical image processing software and axis deviation was diagnosed with ortho X-ray. Patients were divided into two groups. ACM only (Group 1) and ACM-HTO (Group 2).Results: ACM only group consists of 5 patients. Preoperative mean of chondral lesion volume was 77.11±137.5 (0.27-321.61). Post-operative mean Knee score was 175.20±24.4(150-203) and chondral lesion volume was 0.3±0.03(0-0.8). ACM-HTO group consists of 7 patients. Preoperative mean of chondral lesion volume was 112.72±239(0.27-653). Post-operative mean of HSS score was 155±20.4(135-183) and chondral lesion volume was 0.26±0.09(0-0.69). Conclusion:According to these results, all patients' HSS scores and Cartilage volume are increased, but there were no significant differences were found between two groups.Keywords: cartilage, high tibial osteotomy, acellular collagen matrix Sonuç: Bu sonuçlara göre, tüm hastaların HSS skorları ve kıkırdak hacmi artmıştır ancak iki grup arasında anlamlı bir farklılık bulunmamaktadır.

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“…However, previous studies have shown that a regenerative response of articular cartilage was observed in several cases after HTO [5][6][7][8][9][10][11][12]. These reports involved either OWHTO or CWHTO, and to the best of our knowledge, no study has directly compared postoperative cartilage repair between OWHTO and CWHTO.…”

Section: Introductionmentioning

confidence: 93%

A comparison of clinical outcomes and cartilage repair between opening wedge and closed wedge high tibial osteotomy procedures in patients with medial osteoarthritis of the knee

Akamatsu

Kumagai

Yamada

et al. 2020

Preprint

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Background: The aim of the present study was to assess differences in clinical outcomes and postoperative cartilage repair between opening wedge high tibial osteotomy (OWHTO) and closed wedge HTO (CWHTO) for medial osteoarthritis (OA) of the knee.Methods: A total of 90 knees of 76 patients who underwent HTO were investigated. OWHTO was performed in 45 knees of 40 patients with a correction angle of 15° or less, and CWHTO was performed in 45 knees of 36 patients with a correction angle of greater than 15°. Initial arthroscopy was performed at the time of HTO, and a second-look arthroscopy was performed at the time of plate removal. Cartilage repair was classified into the following stages: Stage 1 (no reparative change); Stage 2 (partial coverage with white cartilaginous tissue); and Stage 3 (full coverage with white cartilaginous tissue). Clinical outcomes were assessed using Knee Society scores, and radiographic assessment was carried out by measuring the femorotibial angle (FTA).Results: Regarding preoperative OA grade, varus alignment, and function score, CWHTO patients showed more advanced OA status than OWHTO patients. Knee scores and function scores were significantly improved after surgery with both HTO procedures (P<0.05), with no significant difference between the two procedures. Cartilage repair of stage 2 or 3 was found in more than 80% of the subjects in the medial femoral condyle and more than 60% in the medial tibial condyle. However, there were no significant differences between the two HTO procedures. There was no relationship between clinical outcomes and postoperative cartilage status in both HTO procedures. Multivariate logistic regression analysis showed that preoperative International Cartilage Repair Society (ICRS) grade was the only factor affecting cartilage repair.Conclusions: CWHTO improved clinical outcomes and cartilage status as much as OWHTO. Although the effects of cartilage repair on clinical outcomes are unknown, HTO is an effective treatment option even for severe medial OA of the knee.

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Factors affecting cartilage repair after medial opening-wedge high tibial osteotomy

Abstract: Level IV, therapeutic case series.

Cited by 70 publications

References 29 publications

Risk factors of cartilage regeneration in patients who underwent high tibial osteotomy combined with microfracture

Risk factors of cartilage regeneration in patients who underwent high tibial osteotomy combined with microfracture

İs Combined Acellular Collagen Matrix and High Tibial Osteotomy Treatment Effective In Osteochondral Defects? Preliminary Study

A comparison of clinical outcomes and cartilage repair between opening wedge and closed wedge high tibial osteotomy procedures in patients with medial osteoarthritis of the knee

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