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Postoperative Decrease in Bone Marrow Lesion Associated With Better Clinical Outcomes Following Medial Open-Wedge

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Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association
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Summary
This summary is machine-generated.

Bone marrow lesions (BMLs) decrease over time after medial open-wedge high tibial osteotomy (MOWHTO). This reduction in BMLs correlates with improved patient-reported outcomes (PROMs) at two years, with valgus alignment being a key factor.

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Area of Science:

  • Orthopedic Surgery
  • Radiology
  • Biomedical Engineering

Background:

  • Bone marrow lesions (BMLs) are common in knee osteoarthritis and can impact patient outcomes.
  • Medial open-wedge high tibial osteotomy (MOWHTO) is a surgical procedure to correct varus malalignment in knee osteoarthritis.
  • Understanding the natural history of BMLs after MOWHTO is crucial for predicting treatment success.

Purpose of the Study:

  • To track serial changes in preoperative bone marrow lesions (BMLs) following medial open-wedge high tibial osteotomy (MOWHTO) for up to two years.
  • To determine if postoperative BML changes influence patient-reported outcome measures (PROMs) at the two-year follow-up.
  • To identify factors associated with postoperative BML changes after MOWHTO.

Main Methods:

  • Retrospective analysis of prospectively collected data from patients undergoing MOWHTO for knee osteoarthritis.
  • Serial MRI scans were obtained preoperatively and at 3, 6, 18, and 24 months postoperatively to assess BML extent.
  • Patient-reported outcome measures (PROMs) were evaluated preoperatively and postoperatively, with analysis of minimal clinically important difference achievement.
  • Linear mixed models were used to analyze the association between BMLs and PROMs over time.
  • Factors influencing BML changes were assessed.

Main Results:

  • Preoperative BMLs were present in 80.8% of patients.
  • A significant decrease in BMLs was observed at medial femoral and tibial condyles postoperatively, continuing to reduce up to 24 months.
  • High proportions of patients achieved minimal clinically important differences in overall WOMBAT and KOOS subscales.
  • Postoperative BML reduction was significantly associated with better PROMs at 24 months.
  • Normo-correction (2°-5° valgus) was a significant factor in reducing BMLs post-MOWHTO.

Conclusions:

  • Preoperative bone marrow lesions (BMLs) demonstrate a gradual decrease over time following medial open-wedge high tibial osteotomy (MOWHTO).
  • The reduction in BMLs post-MOWHTO is significantly correlated with improved patient-reported outcomes (PROMs) at two years.
  • Achieving postoperative valgus alignment is a key factor associated with decreased BMLs after MOWHTO.