Combined Cartilage Procedures After High Tibial Osteotomy: Cartilage Status, Early Functional Recovery, and...

Area of Science:

• Orthopedic surgery
• Regenerative medicine
• Knee osteoarthritis treatment

Background:

• The clinical benefit of combining cartilage procedures with high tibial osteotomy (HTO) is unclear.
• Concerns exist regarding potential increases in early postoperative pain and delayed functional recovery.

Purpose of the Study:

• To determine if concurrent cartilage procedures with HTO increase pain or delay functional recovery in the early postoperative period.
• To compare patient-reported outcomes (PROs) between isolated HTO and HTO combined with microdrilling or mesenchymal stem cell implantation.

Main Methods:

• Retrospective cohort study (Level of evidence, 3) of 93 patients undergoing HTO.
• Patients were grouped into isolated HTO, HTO with microdrilling, or HTO with stem cell implantation.
• PROs were analyzed at 6, 12, and 24 months; MRI and second-look arthroscopy were used for cartilage assessment.

Main Results:

• At 6 months, stem cell implantation (group C) showed less improvement in Lysholm and IKDC scores compared to isolated HTO (group I).
• Lower rates of achieving minimal clinically important differences were observed in groups M and C at 6 months.
• Subchondral edema on MRI correlated with increased pain and poorer function; improved cartilage status on arthroscopy did not correlate with PROs.

Conclusions:

• Concurrent cartilage procedures, particularly microdrilling, with HTO are linked to increased early pain and delayed functional recovery.
• Despite improved cartilage appearance on second-look arthroscopy, clinical outcomes at 12 and 24 months were similar to isolated HTO.