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

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.

scholarly journals Medial Opening Wedge High Tibial Osteotomy Decreases Medial Meniscal Extrusion and Improves Clinical Outcomes and Return to Activity

2020 ◽  
Vol 8 (4) ◽  
pp. 232596712091353 ◽  
Author(s):  
Diego Costa Astur ◽  
Joao Victor Novaretti ◽  
Marcelo Lins Gomes ◽  
Adilson Góes Rodrigues ◽  
Camila Cohen Kaleka ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
High Tibial Osteotomy ◽  
Case Series ◽  
Tibial Osteotomy ◽  
Meniscal Extrusion ◽  
Level Of Evidence ◽  
Opening Wedge ◽  
Wedge High Tibial Osteotomy ◽  
Return To Activity

Background: Medial meniscal extrusion (MME) is defined as displacement of the meniscus that extends beyond the tibial margin. Knee varus malalignment increases MME. Purpose/Hypothesis: The purpose of this study was to quantify MME before and after medial opening wedge high tibial osteotomy (HTO) and to correlate the reduction of MME with clinical outcomes and return to activity. It was hypothesized that MME would decrease after HTO and that patients with lower MME after surgery would have improved clinical outcomes and return to activity at short-term follow-up. Study Design: Case series; Level of evidence, 4. Methods: This study included 66 patients who underwent HTO to correct the anatomic axis with a minimum follow-up of 2 years. MME was measured using magnetic resonance imaging preoperatively and 6 weeks after surgery (study protocol). Patients were assessed preoperatively and postoperatively with the Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS) score for pain, and Tegner score. Results: The mean ± SD preoperative and postoperative MME values were 3.9 ± 0.6 mm and 0.9 ± 0.5 mm, respectively. At 2 years after surgery, KOOS, pain VAS, and Tegner scores were higher than those found preoperatively ( P < .001). Patients with less than 1.5 mm of MME after surgery had better clinical outcomes and return to activity compared with patients who had MME of 1.5 mm or more ( P < .05). Conclusion: Medial opening wedge HTO decreased MME after 6 weeks and improved clinical outcomes and return to activity at a minimum 2-year follow-up. Additionally, patients with postoperative MME of less than 1.5 mm had better clinical outcomes and return to activity compared with patients who had postoperative MME of 1.5 mm or more.

scholarly journals Clinical Outcomes and Complications During and After Medial Open-Wedge High Tibial Osteotomy Using a Locking Plate: A 3- to 7-Year Follow-up Study

2020 ◽  
Vol 8 (6) ◽  
pp. 232596712092253
Author(s):  
Koji Yabuuchi ◽  
Eiji Kondo ◽  
Jun Onodera ◽  
Tomohiro Onodera ◽  
Tomonori Yagi ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
High Tibial Osteotomy ◽  
Locking Plate ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Major Complications ◽  
Cumulative Rate ◽  
Wedge High Tibial Osteotomy ◽  
The Mean

Background: Outcomes and complications at mid- or long-term follow-up after medial open-wedge high tibial osteotomy (MOWHTO) with the TomoFix locking plate have not been fully evaluated. Purpose: To evaluate the complications and midterm clinical outcomes after MOWHTO using a TomoFix. Study Design: Case series; Level of evidence, 4. Methods: Enrolled in this study were 80 patients (85 knees) who underwent MOWHTO with the TomoFix locking plate between 2009 and 2013. There were 66 women and 14 men, with a mean age of 61.5 years at the time of surgery. The diagnosis was medial osteoarthritis in 76 knees and spontaneous osteonecrosis of the knee in 9 knees. Metal removal and second-look arthroscopy were performed in all cases. Clinical and radiological examinations were performed at final follow-up after surgery (mean, 4.5 years). Results: The mean Japanese Orthopaedic Association score and Knee injury and Osteoarthritis Outcome Score improved significantly from pre- to postoperatively ( P < .0001). The weightbearing line percentage shifted to pass through a point 67.7% lateral from the medial edge of the tibial plateau. The Caton-Deschamps index changed significantly from 0.88 to 0.66 at final follow-up ( P < .0001). The mean posterior tibial slope changed significantly from 8.9° to 11.9° at final follow-up ( P < .0001). Limb length was significantly increased after MOWHTO (10.3 mm; P < .0001). During plate removal, 14 locking screws were found to be broken in 9 knees (10.6%). The articular cartilage grade of the patellofemoral joint was significantly higher in the second arthroscopy than in the first arthroscopy ( P < .0001). The cumulative rate of all complications was 41.2%, with major complications (ie, those requiring additional or extended treatment) in 24.7%. Conclusion: Postoperative outcome scores indicated significant improvement after MOWHTO, although the cumulative rate of all complications was 41.2% and the rate of major complications was 24.7%. These results indicate that MOWHTO with the TomoFix is a technically demanding procedure. Careful preoperative planning and meticulous surgical technique are needed to decrease the incidence of complications associated with MOWHTO.

Factors affecting cartilage repair after medial opening-wedge high tibial osteotomy

2016 ◽  
Vol 25 (3) ◽  
pp. 779-784 ◽  
Author(s):  
Ken Kumagai ◽  
Yasushi Akamatsu ◽  
Hideo Kobayashi ◽  
Yoshihiro Kusayama ◽  
Tomihisa Koshino ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Cartilage Repair ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Factors Affecting ◽  
Wedge High Tibial Osteotomy

scholarly journals EVALUATION OF OUTCOME OF MEDIAL OPENING WEDGE HIGH TIBIAL OSTEOTOMY FOR UNICOMPARTMENTAL KNEE OSTEOARTHRITIS

2020 ◽  
pp. 1-4
Author(s):  
R. N. Shewale ◽  
Ketan J. Khatri
Keyword(s):  
Knee Osteoarthritis ◽  
Functional Outcome ◽  
High Tibial Osteotomy ◽  
Medial Compartment ◽  
Functional Score ◽  
Tibial Osteotomy ◽  
Knee Score ◽  
Opening Wedge ◽  
Wedge High Tibial Osteotomy ◽  
The Mean

Background: Osteoarthritis is often found in weight-bearing joints, the knee being the most common site. Most patients of symptomatic osteoarthritis of knee are associated with varus malalignment that is causative or contributory to painful arthritis. Correcting the malalignment of the knee relieves symptoms by transferring the functional load to the unaffected compartment. The goal of the treatment is to relieve medial compartment knee pain and slow down the arthritic progression. We report the outcome of a simple technique of medial opening wedge high tibial osteotomy in treating the medial compartment osteoarthritis of the knee. Materials and method: A prospective interventional study was carried out over a period of 2 years from November 2017 to October 2019 in a sample size of randomly selected 41 patients having unilateral knee osteoarthritis. All patients after a proper preoperative assessment underwent high tibial osteotomy and the outcome was evaluated using knee society scoring system. Results: The age of the patients ranged from 40 – 65 years with a mean age of 51 years, 13 were males and 28 were females showing female predominance (68.2%). The mean knee score and the mean functional score of the patients before surgery were 60 and 61.95 respectively and post operatively at the end of 6 months the knee score and functional score was 77 and 80.53 respectively. By the end of 6 months out of 41 patients, 12 patients (29.2%) had excellent functional outcome, 18 patients (43.90%) had good functional outcome, 09 patients (21.95%) had fair functional outcome while only 02 patients (04.87%) had poor functional outcome. Conclusions: The present study shows that HTO is a good option in isolated medial compartment OA of knee. Significant increase in the knee score and functional score was found after high tibial osteotomy for the patients of osteoarthritis with varus deformity. Success of high tibial osteotomy relies on appropriate patient selection, proper osteotomy type and precise surgical technique.

Survivorship of medial opening wedge high tibial osteotomy in the elderly: two to ten years of follow up

2017 ◽  
Vol 41 (10) ◽  
pp. 2045-2052 ◽  
Author(s):  
Pakpoom Ruangsomboon ◽  
Keerati Chareancholvanich ◽  
Thos Harnroongroj ◽  
Chaturong Pornrattanamaneewong
Keyword(s):  
High Tibial Osteotomy ◽  
The Elderly ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Wedge High Tibial Osteotomy

scholarly journals The difficulty of continuing sports activities after open-wedge high tibial osteotomy in patient with medial knee osteoarthritis: a retrospective case series at 2-year-minimum follow-up

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Shugo Maeda ◽  
Daisuke Chiba ◽  
Eiji Sasaki ◽  
Tetsushi Oyama ◽  
Tomoyuki Sasaki ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Case Series ◽  
Tibial Osteotomy ◽  
Activity Levels ◽  
Open Wedge ◽  
Retrospective Case ◽  
Sports Activity ◽  
Wedge High Tibial Osteotomy ◽  
The Mean

Abstract Purpose This study aimed to investigate the rate at which patients returned to sports after open wedge high tibial osteotomy and identify the continuity of sports activity post-operatively. Methods Thirty-five patients (40 knees) who underwent open-wedge high tibial osteotomy (OW-HTO) in medial knee osteoarthritis were included in this study. The mean age of the patients who underwent surgery was 55.1 ± 10.7 years, and the mean follow-up period was 41.0 ± 24.7 months. Clinical results and radiographic parameters calculated in standing whole-leg radiographs preoperatively, post-operatively, and at the final follow-up were evaluated. Results Thirty-one patients (88.6%) were able to return to preoperative sports activity; however, only 14 patients (40.0%) completely returned to preoperative sports activity levels. Of the 31 patients who returned to sports activity, 10 patients (32.3%) maintained post-operative sporting activity levels at the final follow-up. In radiographic parameters, the weight-bearing line ratio was considered loss of correction in the post-operative period leading to the final follow-up. Patients who completely returned to sports and maintained sporting activity levels at the final follow-up had significantly higher the Knee Injury and Osteoarthritis Outcome Score pain subscale values and lower visual analogue scale of knee pain at pre-surgery and final follow-up than other patients, including those who partially returned to sports. Conclusions The proportion of patients who returned to sports after OW-HTO and were able to participate in competitions at the same activity level as before surgery was low and insufficient. Level of evidence Retrospective case series, IV

scholarly journals A comparison of clinical outcomes and cartilage repair between opening wedge and closed wedge high tibial osteotomy procedures in patients with medial osteoarthritis of the knee

2020 ◽  
Author(s):  
Tomotaka Akamatsu ◽  
Ken Kumagai ◽  
Shunsuke Yamada ◽  
Shuntaro Nejima ◽  
Masaichi Sotozawa ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Cartilage Repair ◽  
Tibial Osteotomy ◽  
Cartilaginous Tissue ◽  
Opening Wedge ◽  
Correction Angle ◽  
Closed Wedge ◽  
Wedge High Tibial Osteotomy ◽  
And Function ◽  
And Cartilage

Abstract Background: The aim of the present study was to assess differences in clinical outcomes and postoperative cartilage repair between opening wedge high tibial osteotomy (OWHTO) and closed wedge HTO (CWHTO) for medial osteoarthritis (OA) of the knee.Methods: A total of 90 knees of 76 patients who underwent HTO were investigated. OWHTO was performed in 45 knees of 40 patients with a correction angle of 15° or less, and CWHTO was performed in 45 knees of 36 patients with a correction angle of greater than 15°. Initial arthroscopy was performed at the time of HTO, and a second-look arthroscopy was performed at the time of plate removal. Cartilage repair was classified into the following stages: Stage 1 (no reparative change); Stage 2 (partial coverage with white cartilaginous tissue); and Stage 3 (full coverage with white cartilaginous tissue). Clinical outcomes were assessed using Knee Society scores, and radiographic assessment was carried out by measuring the femorotibial angle (FTA).Results: Regarding preoperative OA grade, varus alignment, and function score, CWHTO patients showed more advanced OA status than OWHTO patients. Knee scores and function scores were significantly improved after surgery with both HTO procedures (P<0.05), with no significant difference between the two procedures. Cartilage repair of stage 2 or 3 was found in more than 80% of the subjects in the medial femoral condyle and more than 60% in the medial tibial condyle. However, there were no significant differences between the two HTO procedures. There was no relationship between clinical outcomes and postoperative cartilage status in both HTO procedures. Multivariate logistic regression analysis showed that preoperative International Cartilage Repair Society (ICRS) grade was the only factor affecting cartilage repair.Conclusions: CWHTO improved clinical outcomes and cartilage status as much as OWHTO. Although the effects of cartilage repair on clinical outcomes are unknown, HTO is an effective treatment option even for severe medial OA of the knee.

Sign in / Sign up

Export Citation Format

Share Document