Malalignment: A Requirement for Cartilage and Organ Restoration

Abstract

The treatment of combined knee pathology is a challenging problem that requires careful attention to all aspects of the underlying disease. This is true of the interplay among malalignment and meniscal or articular cartilage restoration in the knee. Optimal outcomes are contingent on a comprehensive preoperative evaluation of patient-specific factors (patient expectations, patient age, and activity level), as well as disease-specific factors of the knee. Surgical intervention for meniscal or chondral deficiencies without attention to malalignment will lead to inferior outcomes. The focus of this review is to highlight the importance of malalignment correction when treating meniscal and articular cartilage pathology. This objective will be accomplished by outlining the approach to the preoperative evaluation, discussing the indications for surgical intervention, reviewing the preferred surgical techniques for correcting coronal malalignment of the knee, and providing a discussion of clinical outcomes.

Patient-Reported Outcomes for Large Bipolar Osteochondral Allograft Transplantation in Combination with Realignment Osteotomies for the Knee

“…One comorbidity that is universally agreed upon as significantly influencing outcomes after OCA transplantation in the knee is lower extremity malalignment, yet there is currently relatively little evidence regarding type and timing of associated osteotomies on patient outcomes. 14,[24][25][26][27][28][29] Type and timing of osteotomies about the knee have potential for positive and negative influences on bipolar OCA transplantation outcomes. These osteotomies may protect OCAs from overloading but can compromise blood flow to donor tissues during healing and incorporation.…”

Cartilage repair strategies in the knee according to Dutch Orthopedic Surgeons: a survey study

“…The incidence of severe cartilage defects with ACL injuries for instance was previously found to be 16-46% [21]. On the other hand, there is also an increasing notion that combined treatments might decrease the risk for reoperation and improve outcomes [20,[22][23][24]. With a leg axis corrections considered at 5°-6° malalignment, most correspondents follow the DCS.…”

“…Some experts in the field, however, have advocated to correct malalignment in the mechanical axis from 2 degrees or more to unload the treated compartment and enhance repair. [22,25] In a recent German database study the cut-off for varus axis correction was 3° [23]. Emphasized by the obesity pandemic, it is of great relevance to further clarify the indication and cut-off values for alignment corrections or overcorrections since unloading is potentially beneficial for the repair [22,26].…”

A 2021 consensus statement on osteotomies around the knee by the UK Knee Osteotomy consensus Group (KOG)

“…Questions remain however, on whether UKR's do buy patients time, with the Danish registry reporting twice as high revision rates of TKR following UKR compared to osteotomy [7]. More latterly the indications for osteotomy have been extended to cartilage repair [8], meniscus deficiency [9] and ligamentous instability [10].…”