Clinical Outcomes and Cartilage Regeneration Using Osteochondral Autograft Transfer System and Medial Open-Wedge High...

Osteochondral defects of the medial femoral condyle, particularly in varus-aligned knees, pose significant clinical challenges due to the risk of progression to osteoarthritis. Osteochondral autograft transplantation (OATS) restores the cartilage-subchondral unit, while medial open-wedge high tibial osteotomy (MOWHTO) addresses malalignment. This study evaluates clinical, radiological, and survivorship outcomes following combined OATS and MOWHTO supplemented with platelet-rich plasma in patients with symptomatic medial femoral condyle defects. A prospective observational study was conducted on 13 patients (15 knees) treated with combined OATS and MOWHTO. Inclusion criteria included symptomatic full-thickness osteochondral defects (>1 cm²), varus malalignment (>3 degrees), and failure of conservative management. Pre- and postoperative assessments included Knee Society Score (KSS), visual analog scale (VAS), range of motion (ROM), radiographs, and magnetic resonance imaging (MRI). Follow-up was a minimum of 2 years. Statistical analyses were performed using paired t-tests and Kaplan-Meier survival analysis. The mean age was 36.7 years. The mean defect size was 2.1 cm² with an average preoperative varus of 5.4 degrees. Significant improvements were seen in KSS (knee: 48.3-90.4; function: 42.6-88.7), VAS (7.2-1.8), and ROM (96-122 degrees), all p < 0.05. MRI at 24 months showed excellent graft integration (mean MOCART score: 89.6). Mechanical alignment was corrected to a mean of 62.3% lateral. One minor complication was noted, and no cases required revision or conversion to arthroplasty. Overall survivorship was 96.7%. Combined OATS and MOWHTO is a safe, effective solution for young, active patients with focal cartilage defects and varus malalignment, offering substantial clinical and radiological improvements. Longer-term studies are warranted.