Evaluation of regenerated cartilage using T2 mapping methods after opening-wedge high tibial osteotomy with microfracture at the cartilage defect: a preliminary study

Abstract Purpose This study evaluated the regenerated cartilage after opening-wedge high tibial osteotomy (OWHTO) with concomitant microfracture by second-look arthroscopy, Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score and magnetic resonance imaging (MRI) T2 mapping. It was hypothesised that cartilage regeneration can be achieved by HTO, but the quality of regenerated cartilage is not normal cartilage. Methods OWHTO was performed in eight knees of seven patients (mean age, 57.6 ± 5.2 years). Microfracture for the cartilage defect was performed followed by OWHTO, and second-look arthroscopy was performed at the time of plate removal (14.1 ± 4.5 months after OWHTO). MRI was assessed at three months and one year after surgery. The status of articular cartilage regeneration was assessed by the ICRS grade, MOCART score and T2 value. Results The number of subjects in ICRS grade 1/2/3/4 changed significantly from 0/0/4/4 preoperatively to 0/2/6/0 postoperatively in the medial femoral condyle (MFC) (P < 0.05) and 0/0/0/8 preoperatively to 0/0/7/1 postoperatively in the medial tibial plateau (MTP) (P < 0.05). Mean MOCART scores for MFC and MTP at one year after surgery exhibited significant increases compared with the results at three months after surgery. Mean T2 values for MFC and MTP did not differ at three months and one year after surgery. Conclusion The appearance and morphological evaluation by ICRS grade and MOCART score of regenerated cartilage were improved after OWHTO with concomitant microfracture. However, there were no significant qualitative differences in T2 values. This suggests that the regenerated cartilage tissue was likely to be insufficient cartilage. Level of evidence Level IV, therapeutic case series.

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Second-Look Arthroscopic Assessment of Cartilage Regeneration After Medial Opening-Wedge High Tibial Osteotomy

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2013.10.008 ◽

2014 ◽

Vol 30 (1) ◽

pp. 72-79 ◽

Cited By ~ 82

Author(s):

Woon-Hwa Jung ◽

Ryohei Takeuchi ◽

Chung-Woo Chun ◽

Jung-Su Lee ◽

Jae-Hun Ha ◽

...

Keyword(s):

High Tibial Osteotomy ◽

Cartilage Regeneration ◽

Tibial Osteotomy ◽

Opening Wedge ◽

Second Look ◽

Wedge High Tibial Osteotomy

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Second-look arthroscopic cartilage status is related to intermediate-term outcomes after medial opening-wedge high tibial osteotomy

The Bone & Joint Journal ◽

10.1302/0301-620x.103b11.bjj-2020-2130.r2 ◽

2021 ◽

Vol 103-B (11) ◽

pp. 1686-1694

Author(s):

Hong-Yeol Yang ◽

Woo-Kyoung Kwak ◽

Sung Ju Kang ◽

Eun-Kyoo Song ◽

Jong-Keun Seon

Keyword(s):

Clinical Outcomes ◽

High Tibial Osteotomy ◽

Cartilage Repair ◽

Tibial Osteotomy ◽

Opening Wedge ◽

Status Group ◽

Second Look ◽

Wedge High Tibial Osteotomy ◽

The Mean

Aims To determine the relationship between articular cartilage status and clinical outcomes after medial opening-wedge high tibial osteotomy (MOHTO) for medial compartmental knee osteoarthritis at intermediate follow-up. Methods We reviewed 155 patients (155 knees) who underwent MOHTO from January 2008 to December 2016 followed by second-look arthroscopy with a mean 5.3-year follow-up (2.0 to 11.7). Arthroscopic findings were assessed according to the International Cartilage Repair Society (ICRS) Cartilage Repair Assessment (CRA) grading system. Patients were divided into two groups based on the presence of normal or nearly normal quality cartilage in the medial femoral condyle: good (second-look arthroscopic) status (ICRS grade I or II; n = 70), and poor (second-look arthroscopic) status (ICRS grade III or IV; n = 85) groups at the time of second-look arthroscopy. Clinical outcomes were assessed using the International Knee Documentation Committee (IKDC) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 36-Item Short Form survey. Results Significant improvements in all clinical outcome categories were found between the preoperative and second-look arthroscopic assessments in both groups (p < 0.001). At the latest follow-up, the mean IKDC and WOMAC scores in the good status group further improved compared with those at the time of second-look arthroscopic surgery (p < 0.001), which was not shown in the poor status group. The mean IKDC (good status, 72.8 (SD 12.5); poor status, 64.7 (SD 12.1); p = 0.002) and mean WOMAC scores (good status, 15.7 (SD 10.8); poor status, 21.8 (SD 13.6); p = 0.004) significantly differed between both groups at the latest follow-up. Moreover, significant correlations were observed between ICRS CRA grades and IKDC scores (negative correlation; p < 0.001) and WOMAC scores (positive correlation; p < 0.001) at the latest follow-up. Good cartilage status was found more frequently in knees with the desired range of 2° to 6° valgus correction than in those with corrections outside this range (p = 0.019). Conclusion Second-look arthroscopic cartilage status correlated with clinical outcomes after MOHTO at intermediate-term follow-up, despite the relatively small clinical differences between groups. Cite this article: Bone Joint J 2021;103-B(11):1686–1694.

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