No differences in clinical outcomes and cartilage repair between opening wedge and closed wedge high tibial osteotomies at short-term follow-up: A retrospective case series analysis

Abstract

Purpose: The aim of this 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 OWHTO (45 knees of 40 patients) and CWHTO (45 knees of 36 patients) was followed-up for 2 years. Cartilage repair at the medial compartment was arthroscopically 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 anatomical femorotibial angle (aFTA). 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. 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.

Combined knee osteotomy and cartilage procedure for varus knees: friend or foe? A narrative review of the literature

“…Several authors have reported better macroscopic cartilage regeneration and improved clinical outcomes following isolated single-or double-level knee osteotomies for patients with variable cartilage defects and extraarticular deformities (10,11,12,13,14,15,16,17,18,19,20,21,22,23,24). More recently, Kim et al 2022 (14) evaluated cartilage regeneration following medial opening wedge high tibial osteotomy (MOWHTO) for medial compartment osteoarthritis (OA) with or without radiographic kissing lesions (RKL).…”

Difference in the anterior displacement of the tibial tuberosity relative to the proximal tibial fragment between opening wedge and closed wedge high tibial osteotomies

“…In contrast, a greater correction is feasible in CWHTO. The choice between the two techniques was determined preoperatively in accordance with the angular correction, following our institutional guideline [10][11][12]. Specifically, OWHTO was carried out in knees with an angular correction of 15°or less, while CWHTO was chosen for knees with an angular correction exceeding 15°.…”