Knee joint preservation with combined neutralising High Tibial Osteotomy (HTO) and Matrix-induced Autologous Chondrocyte Implantation (MACI) in younger patients with medial knee osteoarthritis: A case series with prospective clinical and MRI follow-up over 5years

Can young and active patients participate in sports after osteochondral autologous transfer combined with valgus high tibial osteotomy?

“…Better clinical results were seen after OAT compared with microfracture in these patients [12,13]. Autologous chondrocyte transplantation can successfully be used in larger lesions, but is mainly limited by the depth of the defect [3,30,32]. This 2-step procedure can be combined with autologous cancellous bone grafting, but has remained an expensive technique [31,38].…”

Success of High Tibial Osteotomy in the United States Military

“…Functional reports of HTO in young, athletic patient populations are also limited, 3,14 particularly when combined with other intra-articular knee procedures. 2,10,16,19,21,31 To this end, the current investigation reports on the clinical, functional, and occupational outcomes of 181 physically active military service members undergoing HTO with 2-to 8-year follow-up. Of this cohort, 72% of patients returned to military duty without secondary conversion to knee arthroplasty.…”

“…The existing literature suggests that clinical outcomes after chondral restoration procedures, such as autologous chondrocyte implantation (ACI), 2,3 osteoarticular autograft transfer surgery (OATS), 17 and osteochondral allograft transplantation, 26 for focal chondral defects might significantly benefit from mechanical offloading. Subtle corrective osteotomies have also optimized survivorship with medial meniscal allograft transplantation 27 and may synergistically act to delay the progression of medial joint line degeneration when compared with meniscal transplantation alone.…”

“…Similarly, current military status and performance of a postoperative deployment were identified from the Pentagon Defense Manpower Data Center database, and the US Army Physical Disability Agency database was cross-referenced to identify all Army service members with confirmed kneerelated medical discharge. For the purposes of this study, clinical failure after primary HTO was defined as either (1) initiation of the knee-related medical discharge or (2) conversion to knee arthroplasty.…”

Autologous Chondrocyte Implantation: Scaffold-Based Solutions

“…As a salvage operation in young patients with medial compartment osteoarthritis, Bauer et al report significant clinical improvement at 5 years with combined high tibial osteotomy and MACI; however, they note declining results and high graft failure over time for this salvage operation [30]. Finally, outcomes for MACI and concomitant bone grafting for treatment of osteochondral lesions with use of a bilayer 'sandwich' technique have also been reported.…”