Return to Sport Following High Tibial Osteotomy With Concomitant Osteochondral Allograft Transplantation

Abstract

Background: Young patients with symptomatic chondral defects in the medial compartment with varus malalignment may undergo opening wedge high tibial osteotomy (HTO) with concomitant osteochondral allograft transplantation (OCA) (HTO + OCA). Although patients have demonstrated favorable outcomes after HTO + OCA, limited information is available regarding return to sporting activities after this procedure. Purpose: To evaluate (1) the timeline to return to sports (RTS), (2) patient satisfaction, and (3) reasons for discontinuing sporting activity after HTO + OCA, and to identify predictive factors of RTS. Study Design: Case series; level of evidence, 4. Methods: Consecutive patients who underwent HTO + OCA for varus deformity and medial femoral condyle focal chondral defects with a minimum 2-year follow-up were retrospectively reviewed. Patients completed a subjective sports questionnaire, satisfaction questionnaire, visual analog scale for pain, and Single Assessment Numerical Evaluation. Results: Twenty-eight patients with a mean age of 36.97 ± 7.52 years were included at mean follow-up of 6.63 ± 4.06 years. Fourteen patients (50.0%) required reoperation during the follow-up period, with 3 (10.7%) undergoing knee arthroplasty. Twenty-four patients participated in sports within 3 years before surgery, with 19 patients (79.2%) able to return to at least 1 sport at a mean 11.41 ± 6.42 months postoperatively. However, only 41.7% (n = 10) were able to return to their preoperative level. The most common reasons for sports discontinuation (n = 20; 83.3%) were a desire to prevent further damage to the knee (70.0%), persistent pain (55.0%), persistent swelling (30.0%), and fear (25.0%). Conclusion: In young, active patients with varus deformity and focal medial femoral condyle chondral defects, HTO + OCA enabled 79.2% of patients to RTS by 11.41 ± 6.42 months postoperatively. However, only 41.7% of patients were able to return to their preinjury level or better. It is imperative that patients be appropriately educated to manage postoperative expectations regarding sports participation after HTO + OCA.

Treatment of Malalignment and Cartilage Injury: High Tibial Osteotomy With a Concomitant Osteochondral Allograft to the Medial Femoral Condyle and Lateral and Medial Partial Meniscectomy

“…2 Recently, another group investigated 39 patients (average age, 36 AE 7.9 years) who underwent opening-wedge HTO and OCA transplantation of medial femoral condyle defects; the authors reported that 96.2% of patients were able to return to work by 3.5 AE 2.9 months and 79.2% were able to return to sport, with 41.7% able to return at the same level of competition postoperatively. 7,8 Together, these studies show the combination of HTO and OCA transplantation to be an effective and safe procedure in younger patients with unicompartmental osteoarthritis. Nonetheless, more studies with larger patient populations and longer-term follow-up are needed to further investigate functional outcomes and elucidate the limits of this procedure.…”

High Tibial Osteotomy for Varus Deformity of the Knee

“…Furthermore, HTO with combined osteochondral allograft reconstruction for focal medial femoral condyle lesions resulted in a 79% return to sport at less than 1 year postoperatively; however, only 42% of those patients returned at the same level. 33 Therefore, appropriate education and expectation management is necessary, especially in the young athlete; however, predictable return to sporting activities is possible. The most common alternative to HTO is medial unicompartmental knee arthroplasty, which has been show in some studies to be equally effective in restoring patients' activity levels.…”

Can soccer players return to sport after knee realignment osteotomy?

“…Of all the patients who stopped or decreased playing sports postoperatively, the most common reason was fear of developing progressive damage to their knee, followed by persistent pain. 30 Liu et al published another series of patients who underwent HTO with concomitant medial meniscus allograft transplantation. In this series, the overall return to sport rate was 88%.…”

“…Of those patients who played soccer, 0 of the 6 patients were able to return to their sport. 30 The same institution also published their results on patients who underwent HTO with concomitant medial meniscus allograft transplantation and found that 0 of the 5 soccer players were able to return to playing soccer. 31 A study reporting on results of DFO with concomitant lateral meniscus allograft transplantation noted that 1 of the 4 soccer players was able to return to playing soccer postoperatively.…”