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Effectiveness of concurrent procedures during high tibial osteotomy for medial compartment osteoarthritis: a
O-Sung Lee1, Soyeon Ahn2, Jin Hwan Ahn3
1Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea.
Insights
Concurrent cartilage procedures during high tibial osteotomy (HTO) for osteoarthritis (OA) show minimal clinical benefits. While arthroscopic and MRI results may improve, cartilage quality is not fully restored, making these procedures optional for medial compartment OA.
Area of Science:
- Orthopedics
- Sports Medicine
- Regenerative Medicine
Background:
- Medial compartment osteoarthritis (OA) is a common condition.
- High tibial osteotomy (HTO) is a surgical procedure used to treat knee OA.
- Concurrent cartilage procedures aim to improve outcomes of HTO.
Purpose of the Study:
- To evaluate the efficacy of concurrent cartilage procedures during HTO for medial compartment OA.
- To compare outcomes of HTO plus concurrent cartilage procedures versus HTO alone.
Main Methods:
- Systematic review and meta-analysis of seven comparative studies.
- Forest plots used for results with more than two articles.
- Random effects model and I-squared statistic for heterogeneity analysis.
Main Results:
- No significant difference in Hospital for Special Surgery scores or mechanical femorotibial angle.
- Improved arthroscopic, histologic, and MRI findings in the concurrent procedure group.
- Heterogeneity observed in clinical outcome data (I-squared 80.8%).
Conclusions:
- Concurrent procedures offer limited clinical and radiological benefits for medial compartment OA.
- Potential benefits in arthroscopic, histologic, and MRI outcomes, but cartilage quality remains suboptimal.
- Procedures are considered optional; further research needed for specific patient groups like younger individuals with focal defects.
Introduction:
The purpose of this systematic review and meta-analysis was to evaluate the efficacy of concurrent cartilage procedures during high tibial osteotomy (HTO) for medial compartment osteoarthritis (OA) by comparing the outcomes of studies that directly compared the use of HTO plus concurrent cartilage procedures versus HTO alone.
Materials And Methods:
Results that are possible to be compared in more than two articles were presented as forest plots. A 95% confidence interval was calculated for each effect size, and we calculated the I 2 statistic, which presents the percentage of total variation attributable to the heterogeneity among studies. The random effects model was used to calculate the effect size.
Results:
Seven articles were included to the final analysis. Case groups were composed of HTO without concurrent procedures and control groups were composed of HTO with concurrent procedures such as marrow stimulation procedure, mesenchymal stem cell transplantation, and injection. The case group showed a higher hospital for special surgery score and mean difference was 4.10 [I 2 80.8%, 95% confidence interval (CI) - 9.02 to 4.82]. Mean difference of the mechanical femorotibial angle in five studies was 0.08° (I 2 0%, 95% CI - 0.26 to 0.43). However, improved arthroscopic, histologic, and MRI results were reported in the control group.
Conclusion:
Our analysis support that concurrent procedures during HTO for medial compartment OA have little beneficial effect regarding clinical and radiological outcomes. However, they might have some beneficial effects in terms of arthroscopic, histologic, and MRI findings even though the quality of healed cartilage is not good as that of original cartilage. Therefore, until now, concurrent procedures for medial compartment OA have been considered optional. Nevertheless, no conclusions can be drawn for younger patients with focal cartilage defects and concomitant varus deformity. This question needs to be addressed separately.
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