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Effectiveness of concurrent procedures during high tibial osteotomy for medial compartment osteoarthritis: a systematic review and meta-analysis

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The purpose of this systematic review and meta-analysis was to evaluate the efficacy of concurrent cartilage procedures during high tibial osteotomy (HTO) for medial compartment osteoarthritis (OA) by comparing the outcomes of studies that directly compared the use of HTO plus concurrent cartilage procedures versus HTO alone.

Materials and methods

Results that are possible to be compared in more than two articles were presented as forest plots. A 95% confidence interval was calculated for each effect size, and we calculated the I 2 statistic, which presents the percentage of total variation attributable to the heterogeneity among studies. The random effects model was used to calculate the effect size.

Results

Seven articles were included to the final analysis. Case groups were composed of HTO without concurrent procedures and control groups were composed of HTO with concurrent procedures such as marrow stimulation procedure, mesenchymal stem cell transplantation, and injection. The case group showed a higher hospital for special surgery score and mean difference was 4.10 [I 2 80.8%, 95% confidence interval (CI) − 9.02 to 4.82]. Mean difference of the mechanical femorotibial angle in five studies was 0.08° (I 2 0%, 95% CI − 0.26 to 0.43). However, improved arthroscopic, histologic, and MRI results were reported in the control group.

Conclusion

Our analysis support that concurrent procedures during HTO for medial compartment OA have little beneficial effect regarding clinical and radiological outcomes. However, they might have some beneficial effects in terms of arthroscopic, histologic, and MRI findings even though the quality of healed cartilage is not good as that of original cartilage. Therefore, until now, concurrent procedures for medial compartment OA have been considered optional. Nevertheless, no conclusions can be drawn for younger patients with focal cartilage defects and concomitant varus deformity. This question needs to be addressed separately.

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References

  1. Akizuki S, Yasukawa Y, Takizawa T (1997) Does arthroscopic abrasion arthroplasty promote cartilage regeneration in osteoarthritic knees with eburnation? A prospective study of high tibial osteotomy with abrasion arthroplasty versus high tibial osteotomy alone. Arthroscopy 13:9–17

    Article  CAS  PubMed  Google Scholar 

  2. Chareancholvanich K, Pornrattanamaneewong C, Narkbunnam R (2014) Increased cartilage volume after injection of hyaluronic acid in osteoarthritis knee patients who underwent high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 22:1415–1423

    Article  PubMed  Google Scholar 

  3. Ferruzzi A, Buda R, Cavallo M, Timoncini A, Natali S, Giannini S (2014) Cartilage repair procedures associated with high tibial osteotomy in varus knees: clinical results at 11 years’ follow-up. Knee 21:445–450

    Article  CAS  PubMed  Google Scholar 

  4. Franceschi F, Longo UG, Ruzzini L, Marinozzi A, Maffulli N, Denaro V (2008) Simultaneous arthroscopic implantation of autologous chondrocytes and high tibial osteotomy for tibial chondral defects in the varus knee. Knee 15:309–313

    Article  PubMed  Google Scholar 

  5. Harris JD, McNeilan R, Siston RA, Flanigan DC (2013) Survival and clinical outcome of isolated high tibial osteotomy and combined biological knee reconstruction. Knee 20:154–161

    Article  PubMed  Google Scholar 

  6. Jung WH, Takeuchi R, Chun CW, Lee JS, Ha JH, Kim JH, Jeong JH (2014) Second-look arthroscopic assessment of cartilage regeneration after medial opening-wedge high tibial osteotomy. Arthroscopy 30:72–79

    Article  PubMed  Google Scholar 

  7. Jung WH, Takeuchi R, Chun CW, Lee JS, Jeong JH (2015) Comparison of results of medial opening-wedge high tibial osteotomy with and without subchondral drilling. Arthroscopy 31:673–679

    Article  PubMed  Google Scholar 

  8. Kahlenberg CA, Nwachukwu BU, Hamid KS, Steinhaus ME, Williams RJ (2017) Analysis of outcomes for high tibial osteotomies performed with cartilage restoration techniques. Arthroscopy 33:486–492

    Article  PubMed  Google Scholar 

  9. Koh YG, Kwon OR, Kim YS, Choi YJ (2014) Comparative outcomes of open-wedge high tibial osteotomy with platelet-rich plasma alone or in combination with mesenchymal stem cell treatment: a prospective study. Arthroscopy 30:1453–1460

    Article  PubMed  Google Scholar 

  10. Koshino T, Wada S, Ara Y, Saito T (2003) Regeneration of degenerated articular cartilage after high tibial valgus osteotomy for medial compartmental osteoarthritis of the knee. Knee 10:229–236

    Article  PubMed  Google Scholar 

  11. Kumagai K, Akamatsu Y, Kobayashi H, Kusayama Y, Koshino T, Saito T (2016) Factors affecting cartilage repair after medial opening-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 25:779–984

    Article  PubMed  Google Scholar 

  12. Matsunaga D, Akizuki S, Takizawa T, Yamazaki I, Kuraishi J (2007) Repair of articular cartilage and clinical outcome after osteotomy with microfracture or abrasion arthroplasty for medial gonarthrosis. Knee 14:465–471

    Article  PubMed  Google Scholar 

  13. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 62:1006–1012

    Article  PubMed  Google Scholar 

  14. Pascale W, Luraghi S, Perico L, Pascale V (2011) Do microfractures improve high tibial osteotomy outcome? Orthopedics 34:e251–e255

    PubMed  Google Scholar 

  15. Spahn G, Kirschbaum S, Kahl E (2006) Factors that influence high tibial osteotomy results in patients with medial gonarthritis: a score to predict the results. Osteoarthritis Cartil 14:190–195

    Article  CAS  Google Scholar 

  16. Tang WC, Henderson IJP (2005) High tibial osteotomy: long term survival analysis and patients’ perspective. Knee 12:410–413

    Article  PubMed  Google Scholar 

  17. Wakabayashi S, Akizuki S, Takizawa T, Yasukawa Y (2002) A comparison of the healing potential of fibrillated cartilage versus eburnated bone in osteoarthritic knees after high tibial osteotomy: an arthroscopic study with 1-year follow-up. Arthroscopy 18:272–278

    Article  PubMed  Google Scholar 

  18. Wakitani S, Imoto K, Yamamoto T, Saito M, Murata N, Yoneda M (2002) Human autologous culture expanded bone marrow mesenchymal cell transplantation for repair of cartilage defects in osteoarthritic knees. Osteoarthritis Cartil 10:199–206

    Article  CAS  Google Scholar 

  19. Wong KL, Lee KB, Tai BC, Law P, Lee EH, Hui JH (2013) Injectable cultured bone marrow-derived mesenchymal stem cells in varus knees with cartilage defects undergoing high tibial osteotomy: a prospective, randomized controlled clinical trial with 2 years’ follow-up. Arthroscopy 29:2020–2028

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea

    O-Sung Lee & Yong Seuk Lee

  2. Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, South Korea

    Soyeon Ahn

  3. Department of Orthopaedic Surgery, Sungkyunkwan University College of Medicine, Kangbuk Samsung Hospital, Seoul, South Korea

    Jin Hwan Ahn

  4. Department of Orthopaedic Surgery, Faculty of Medicine, National Orthopaedic Centre of Excellence in Research and Learning (NOCERAL), University of Malaya, Kuala Lumpur, Malaysia

    Seow Hui Teo

Authors
  1. O-Sung Lee
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  2. Soyeon Ahn
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  3. Jin Hwan Ahn
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  5. Yong Seuk Lee
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Corresponding author

Correspondence to Yong Seuk Lee.

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Conflict of interest

The authors declare that we have no conflict of interest.

Funding

This work was supported by Basic Science Research Program through the Ministry of Education of the Republic of Korea and Research Foundation of Korea (NRF) (NRF-2017R1D1A1A9000509).

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Lee, OS., Ahn, S., Ahn, J.H. et al. Effectiveness of concurrent procedures during high tibial osteotomy for medial compartment osteoarthritis: a systematic review and meta-analysis. Arch Orthop Trauma Surg 138, 227–236 (2018). https://doi.org/10.1007/s00402-017-2826-4

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  • DOI: https://doi.org/10.1007/s00402-017-2826-4

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