Cartilage repair procedures associated with high tibial osteotomy in varus knees: Clinical results at 11 years' follow-up

Background and aim: In this study, the authors retrospectively compared the clinical outcome of middle-aged active patients affected by a varus knee with medial unicompartmental osteoarthritis: the treatment was isolated high tibial osteotomy (HTO) for one group or HTO associated with a cartilage repair procedure, that was autologous chondrocyte implantation (ACI) for one group (HTO + ACI) and microfracture (MFX) for the other group (HTO + MFX). The purpose of this study was to analyse the clinical outcomes at long-term follow-up. The hypothesis was that a cartilage repair procedure may add some benefit to isolated axial correction. Methods: 56 patients affected by medial osteoarthcritis in a varus knee were retrospectively investigated: 20 patients were treated by HTO, 18 by HTO + ACI and 18 by HTO + MFX. All patients underwent clinical assessment following HSS and WOMAC rating scores and a radiographic study was performed preoperatively and at follow-up. The statistical analysis confirmed that the three groups of patients were homogeneous regarding clinical, radiographical and anatomopathological patterns; differences have been reported in body mass index (BMI). Results: At final follow-up, improvements in clinical and radiographical results were obtained in all patients. HTO and HTO + ACI series showed significantly higher scores compared to the HTO + MFX series. Conclusions: At more than 11 years of follow-up, isolated HTO and HTO + ACI treatments showed satisfactory results similar to those reported in the literature with no evidence of superiority of the addition of Ad I to isolated HTO. MFX associated with HTO provided the worst results in the series. (C) 2013 Elsevier B.V. All rights reserved.