Analysis of Outcomes for High Tibial Osteotomies Performed With Cartilage Restoration Techniques

Purpose: To evaluate reported medium-to long-term outcomes after high tibial osteotomy (HTO) with associated cartilage restoration procedures. Methods: A review of the MEDLINE database was performed. The inclusion criteria were English language, clinical outcome study with HTO as the primary procedure, use of a form of cartilage repair included, and the mean follow-up period of at least 2 years. Each identified study was reviewed for study design, patient demographics, type of procedures performed, clinical outcomes, progression to total knee arthroplasty, and complications. Results: Eight hundred and twenty-seven patients (839 knees) were included. The most common cartilage preservation technique used in conjunction with HTO was microfracture (4 studies; 22.2%). The mean Lyscholm scores, reported in 50% of the studies, ranged from 40 to 65.7 preoperatively and improved to a range of 67 to 94.6 postoperatively. Four studies (22.2%) used a visual analog scale for evaluation of pain and all had a mean visual analog scale of less than 3 postoperatively. Among studies evaluating conversion to arthroplasty, the rate of conversion was 6.8% and the range of mean number of years from HTO to conversion was 4.9 to 13.0. The overall reported complication rate was 10.3%. Conclusions: HTO with cartilage restoration procedures provides reliable improvement in functional status in the medium- to long-term period after surgery and has potential to delay or avoid the need for knee arthroplasty surgery. Level of Evidence: Level IV, systematic review of Level I to IV studies.