Factors Influencing Clinical and MRI Outcomes of Mesenchymal Stem Cell Implantation With Concomitant High Tibial Osteotomy for Varus Knee Osteoarthritis

Background:Cartilage repair procedures using mesenchymal stem cells (MSCs) can provide superior cartilage regeneration in the medial compartment of the knee joint when high tibial osteotomy (HTO) is performed for varus knee osteoarthritis (OA). However, few studies have reported the factors influencing the outcomes of MSC implantation with concomitant HTO.Purpose:To investigate the outcomes of MSC implantation with concomitant HTO and to identify the prognostic factors that are associated with the outcomes.Study Design:Case series; Level of evidence, 4.Methods:A total of 71 patients (75 knees) were retrospectively evaluated after MSC implantation with concomitant HTO. Clinical and radiological outcomes were evaluated, and magnetic resonance imaging (MRI) was used to assess cartilage regeneration. Statistical analyses were performed to determine the effect of different factors on clinical, radiographic, and MRI outcomes.Results:Clinical and radiographic outcomes improved significantly from preoperatively to final follow-up ( P < .001 for all), and overall cartilage regeneration was encouraging. Significant correlations were found between clinical and MRI outcomes. However, radiographic outcomes were not significantly correlated with clinical or MRI outcomes. Patient age and number of MSCs showed significant correlations with clinical and MRI outcomes. On multivariate analyses, patient age and number of MSCs showed high prognostic significance with poor clinical outcomes.Conclusion:MSC implantation with concomitant HTO provided feasible cartilage regeneration and satisfactory clinical outcomes for patients with varus knee OA. Patient age and number of MSCs were important factors that influenced the clinical and MRI outcomes of MSC implantation with concomitant HTO for varus knee OA.

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HIGH TIBIAL OSTEOTOMY IN THE TREATMENT OF PATIENTS WITH STAGE II–III OF KNEE OSTEOARTHRITIS. IMMEDIATE RESULTS AND FACTORS INFLUENCING THE OUTCOME

Rheumatology Science and Practice ◽

10.14412/1995-4484-2017-668-674 ◽

2017 ◽

Vol 55 (6) ◽

pp. 668-674

Author(s):

V. E. Byalik ◽

S. A. Makarov ◽

L. I. Alekseeva ◽

E. I. Byalik ◽

S. V. Arkhipov ◽

...

Keyword(s):

Knee Osteoarthritis ◽

High Tibial Osteotomy ◽

Stage Ii ◽

Tibial Osteotomy ◽

Factors Influencing

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Arthroscopic Cartilage Regeneration Facilitating Procedure: A Decompressing Arthroplasty for Knee Osteoarthritis

10.21203/rs.3.rs-32928/v1 ◽

2020 ◽

Author(s):

Shaw-Ruey Lyu ◽

Jung-pin Hung ◽

Chia-Chen Hsu ◽

Yu-Ruei Chen ◽

Chih-Wen Lin

Keyword(s):

Knee Osteoarthritis ◽

Cartilage Regeneration ◽

Outcome Study ◽

Knee Oa ◽

Radiographic Outcomes ◽

Operative Care ◽

Medial Plica ◽

Magnetic Resonance Imaging Mri ◽

Objective Outcomes ◽

One Year

Abstract Background The effectiveness of arthroscopic treatment for knee osteoarthritis (OA) has been subject to debate. This study presents an innovative concept of arthroscopic management for knee OA and investigates its clinical outcome.Methods An arthroscopic cartilage regeneration facilitating procedure (ACRFP) to eliminate medial abrasion phenomenon and decompress the patello-femoral joints was performed on 693 knees of 411 patients with knee OA, mean age 60 years (34-90). The Knee Society score (KSS) and the knee injury and osteoarthritis outcome score (KOOS) were used for subjective outcome study. Roentgenographic changes for all cases and magnetic resonance imaging (MRI) variations for twenty randomly selected cases were evaluated for objective outcomes. Results There were 634 knees in 369 patients (93.7%) available with more than 3 years of follow-ups (mean 40 months, SD 9). The overall subjective satisfactory rate was 91.1%. The KSS and all subscales of the KOOS improved statistically. Reversal of the degeneration process of cartilage was observed in 80.1% of the whole series (radiographic outcome) and in 72.2% of the 18 randomly selected cases (one-year MRI outcome study). Gender and OA severity were related to subjective outcomes. Age, body mass index (BMI), pre-operative hyaluronic acid injection, OA severity, and the type and severity of the medial plica are important predictors of radiographic outcomes. An analysis of failed cases reaffirmed the need for early ACRFP and skillful post-operative care. Conclusion ACRFP is an effective treatment for knee OA. If performed in time, it can satisfy most patients and might modify their degeneration process.

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Medium- and long-term results of high tibial osteotomy in patients with primary and secondary knee osteoarthritis with varus deformity

Modern Rheumatology Journal ◽

10.14412/1996-7012-2019-2-38-46 ◽

2019 ◽

Vol 13 (2) ◽

pp. 38-46

Author(s):

V. E. Byalik ◽

S. A. Makarov ◽

L. I. Alekseeva ◽

E. I. Byalik

Keyword(s):

Knee Osteoarthritis ◽

High Tibial Osteotomy ◽

The Body ◽

Long Term Results ◽

Tibial Osteotomy ◽

Female Ratio ◽

Knee Oa ◽

Functional Scores ◽

The Mean

The most common operation for knee osteoarthritis (OA) is total knee arthroplasty (TKA); however, the latter is associated with the development of severe complications. This was the reason for the revival of the interest of orthopedic traumatologists in high tibial osteotomy (HTO), the essence of which is to transfer the load away from the affected medial part of the knee joint (KJ) to the intact lateral one.Objective: to evaluate the medium- and long-term results of open-wedge (OW) HTO in primary and secondary I–III stage knee OA.Patients and methods. The Laboratory of Orthopedic Rheumatology and Rehabilitation, V.A. Nasonova Research Institute of Rheumatology, performed 10 OW HTOs in 9 patients in 2005 to 2009 and 21 more OW HTOs in 19 patients in 2014 to 2018 (a total of 31 operations). The male/female ratio was 2.5:1. The mean age of the patients was 57.6±12.5 years; the body mass index (BMI) was 28.5±3.6 kg/m2 ; the correction angle was 11.7±2.5°. Preoperative planning was performed using the Miniaci method; the X-ray stage of knee OA was evaluated according to the Kellgren–Lawrence classification. OW HTO was carried out. For assessment of its results, the investigators determined the degree of pain using a visual analogue scale (VAS) and the KJ status by the Knee Society Score (KSS) scale. The results were assessed at one (n=31), 3.5±0.6 (n=28), and 8.5±1.3 (n=10) years.Results and discussion. There was a tendency to worsen surgical results over time. The mean VAS values for pain at 1, 3.5, and 8.5 years were as follows: 9.8±10.3; 21.2±16.2 and 38±15.5 mm, respectively. In the same periods, the KSS functional scores were 83.6±14.8, 85.2±12.6, and 80.5±14.2; the objective scores were 80.7±8.5, 75.2±12.7, and 67.8±16.3. There was a strong correlation between the severity of pain and the functional and objective KSS scores (-0.78, -0.81 years, and -0.91 at 1, 3.5, and 8.5 years, respectively; p<0.05). At 3.5±0.6 years, the survival rate after OW HTO was 96.6%. None of the patients examined at 8.5±1.3 years after OW HTO needed TKA. The surgical result was studied in 2 patients at 14 years; one patient underwent TKA, the other refused surgical intervention, the result was satisfactory.Conclusion. OW HTO has limited indications for use. However, in patients who are allowed to undergo this operation, pain syndrome can be relieved, by maintaining and/or improving KJ function; in most cases, TKA can be delayed for more than 10 years.

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Clinical Efficacy of Distal Tibial Tuberosity High Tibial Osteotomy Using The π-Plate in Obese Patients With Varus Knee Osteoarthritis: A Retrospective Study

10.21203/rs.3.rs-129863/v1 ◽

2020 ◽

Author(s):

Xiangdong Tian ◽

Ye Huang ◽

Yetong Tan ◽

Jian Wang ◽

Sheng Ma ◽

...

Keyword(s):

Articular Cartilage ◽

Knee Osteoarthritis ◽

Internal Fixation ◽

High Tibial Osteotomy ◽

Clinical Efficacy ◽

Grading System ◽

Tibial Osteotomy ◽

Obese Patients ◽

Varus Knee

Abstract Background: High tibial osteotomy (HTO) is an effective treatment for varus knee osteoarthritis. However, obese patients require reinforced internal fixation materials to prevent internal fixation fractures and hardware failure after osteotomy. Thus, the purpose of our study was to evaluate the clinical efficacy of distal tibial tuberosity high tibial osteotomy (DTT-HTO) using the new patented π-plate in obese patients with varus knee osteoarthritis.Methods: Thirty-four obese patients (39 knees) with varus knee osteoarthritis who underwent DTT-HTO with the π-plate and second-look arthroscopy when implant removal occurred from September 2017 to June 2020 were retrospectively reviewed. There were 9 males and 25 females, with body mass index (BMI) values ranging from 30.3 to 38.5 kg/m2 and ages ranging from 50 to 75 years old. The radiological assessment was performed with the weight-bearing line ratio (WBLR). The clinical outcomes were evaluated by the Hospital for Special Surgery (HSS) knee score and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The status of the cartilage was evaluated by the International Cartilage Repair Society (ICRS) grading system. Results: All patients were followed up for 18-30 months. The WBLR significantly increased from 16.85±2.20 to 55.41±2.46% from before surgery to the last follow-up after surgery (P<0.001). The HSS score significantly improved from 56.65±5.27 preoperatively to 68.79±2.61, 77.82±2.15, and 86.12±2.78 at the 6-month, 12-month, and last follow-up after surgery (P<0.001). The WOMAC score significantly decreased from 105.47±3.89 preoperatively to 80.50±4.20, 71.44±4.65, and 52.44±3.14 at the 6-month, 12-month, and last follow-up after surgery (P<0.001). During implant removal, no internal fixation fractures occurred in any patient. The articular cartilage grade in the medial compartment of the knee were significantly higher in the second arthroscopy than in the first arthroscopy, according to the ICRS grading system (P < 0.001). The articular cartilage grade in the lateral compartment of the knee showed no statistical differences from the first- to the second-look arthroscopy (p > 0.05).Conclusions: The new patented π-plate is an effective internal fixation material to provide good structural stability in DTT-HTO. And DTT-HTO using the π-plate can yield excellent clinical results in obese patients with varus knee osteoarthritis.

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High tibial osteotomy in combination with arthroscopic abrasion arthroplasty and autologous adipose-derived mesenchymal stem cell therapy in the treatment of advanced knee osteoarthritis

BMJ Case Reports ◽

10.1136/bcr-2018-228003 ◽

2019 ◽

Vol 12 (2) ◽

pp. bcr-2018-228003

Author(s):

Julien Freitag ◽

Cameron Norsworthy ◽

James Wickham ◽

Kiran Shah ◽

Abi Tenen

Keyword(s):

Knee Osteoarthritis ◽

High Tibial Osteotomy ◽

T2 Mapping ◽

Young Patients ◽

Cartilage Regeneration ◽

Tibial Osteotomy ◽

Surgical Interventions ◽

Mesenchymal Stem Cell Therapy ◽

Patient Reported ◽

Total Knee

Osteoarthritis is a progressive and debilitating condition. An increasing number of total knee replacements are being performed under the age of 65. Improved understanding of the action of mesenchymal stem cells (MSC) has seen renewed interest in their role in cartilage repair. A 43-year-old man presented with grade IV medial compartment knee osteoarthritis. The patient underwent high tibial osteotomy (HTO) and arthroscopic abrasion arthroplasty in combination with adipose-derived MSC therapy. The patient reported improvement in pain and function as measured by validated outcome scores. Repeat MRI including T2 mapping techniques showed hyaline-like cartilage regeneration. This case highlights the potential benefit of surgical interventions including HTO in combination with MSC therapy in early-onset severe osteoarthritis. This technique may considerably delay or prevent the need for total knee replacement in young patients. Further controlled trials are needed to confirm the reproducibility of this outcome.

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Comparative Matched-Pair Analysis of Open-Wedge High Tibial Osteotomy With Versus Without an Injection of Adipose-Derived Mesenchymal Stem Cells for Varus Knee Osteoarthritis: Clinical and Second-Look Arthroscopic Results

The American Journal of Sports Medicine ◽

10.1177/0363546518785973 ◽

2018 ◽

Vol 46 (11) ◽

pp. 2669-2677 ◽

Cited By ~ 14

Author(s):

Yong Sang Kim ◽

Yong Gon Koh

Keyword(s):

Clinical Outcomes ◽

Arthroscopic Surgery ◽

Cartilage Regeneration ◽

Conventional Group ◽

Tibial Osteotomy ◽

Varus Knee ◽

Knee Oa ◽

Injection Group ◽

Second Look

Background: High tibial osteotomy (HTO) is reported to be an effective treatment for varus knee osteoarthritis (OA) by redistributing the load line within the knee joint. The cell-based tissue engineering approach using mesenchymal stem cells (MSCs) has addressed the issue of articular cartilage repair in knee OA. Purpose: This study aimed to compare the clinical, radiological, and second-look arthroscopic outcomes of open-wedge HTO with versus without an MSC injection and to identify the association between cartilage regeneration and HTO outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: Among 271 patients treated with HTO for varus knee OA from September 2009 to April 2014, patients treated with HTO alone (conventional group; n = 50) were pair-matched with those who underwent HTO with an MSC injection (injection group; n = 50) based on sex, age, and lesion size. Clinical outcomes were evaluated using the International Knee Documentation Committee (IKDC) score and Lysholm score. Radiological outcomes evaluated were the femorotibial angle and posterior tibial slope. At second-look arthroscopic surgery, cartilage regeneration was evaluated using the International Cartilage Repair Society (ICRS) grade. Results: At the time of second-look arthroscopic surgery (mean, 12.4 months [conventional group] and 12.7 months [injection group]), the mean IKDC and Lysholm scores in each group significantly improved: conventional group, from 38.4 ± 9.2 to 55.2 ± 15.0 and from 56.7 ± 12.2 to 79.6 ± 13.5, respectively; and injection group, from 36.5 ± 4.7 to 62.7 ± 14.1 and from 55.7 ± 11.9 to 80.6 ± 15.6, respectively ( P < .001 for all). Clinical outcomes at final follow-up (mean, 38.8 months [conventional group] and 37.2 months [injection group]) further improved from 62.7 ± 14.1 to 64.8 ± 13.4 (IKDC) and from 80.6 ± 15.6 to 84.7 ± 16.1 (Lysholm) ( P < .001 and P = .034, respectively) only in the injection group when compared with the values at second-look arthroscopic surgery. At final follow-up, there was a significant difference in the mean IKDC and Lysholm scores between groups ( P = .049 and P = .041, respectively). Overall ICRS grades, which significantly correlated with clinical outcomes, were better in the injection group than in the conventional group. Radiological outcomes at final follow-up showed improved knee joint alignment relative to patients’ preoperative conditions but showed no significant correlation with clinical outcomes or ICRS grade in either group ( P > .05 for all). Conclusion: The group that received an MSC injection scored better on the IKDC and Lysholm scales at final follow-up than the group that did not, although these differences were relatively small. When performing HTO for patients with varus knee OA, an MSC injection should be considered as an additional procedure for improved cartilage regeneration with better clinical outcomes.

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