Kim Dong Hyun, Kim Seong Chan, Yoon Ji Soo, Lee Yong Seuk
Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
Orthop J Sports Med. 2020 Jun 23;8(6):2325967120927481. doi: 10.1177/2325967120927481. eCollection 2020 Jun.
Early osteoarthritis of the knee joint mostly affects the medial compartment, making osteotomy a rational approach to slow the progression of the disease. However, some patients show asymptomatic mild degeneration in the lateral or patellofemoral compartment.
To evaluate the effect of asymptomatic mild lateral or patellofemoral degeneration on the outcomes of medial open wedge high tibial osteotomy (OWHTO) by assessing the outcomes according to the preoperative status of the lateral or patellofemoral degenerative changes.
Cohort study; Level of evidence, 3.
A total of 114 patients (121 knees) who underwent biplanar OWHTO with second-look arthroscopic surgery and postoperative magnetic resonance imaging (MRI) were retrospectively enrolled. Patients were categorized into 4 groups according to the Osteoarthritis Research Society International (OARSI) and MRI Osteoarthritis Knee Score (MOAKS) classification systems. The International Cartilage Repair Society (ICRS) grade was used to evaluate the preoperative and postoperative cartilage status. Clinical outcomes were assessed by the American Knee Society (AKS) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 36-item Short Form Health Survey (SF-36).
No degenerative changes in the lateral and patellofemoral compartments of knees (group I) were identified in 51.2% of cases (62 knees). Asymptomatic degenerative changes only in the lateral compartment (group II: OARSI grades 1-3 and MOAKS grades 1-3) were identified in 15.7% of cases (19 knees), changes only in the patellofemoral compartment (group III: OARSI grades 1-3 and MOAKS grades 1-3) were identified in 10.7% of cases (13 knees), and changes in both the lateral and the patellofemoral compartments (group IV) were identified in 22.3% of cases (27 knees). In the medial compartment, there was no significant difference in the improvement of MOAKS and ICRS grades among all groups ( = .813 and .985, respectively). In the lateral and patellofemoral compartments, there was no significant difference in the decline of MOAKS ( = .649 and .421, respectively) and ICRS grades ( = .927 and .676, respectively) among all groups.
The presence of mild lateral or patellofemoral degenerative changes did not affect the MRI, arthroscopic, and clinical outcomes of OWHTO. However, long-term observations are necessary to draw definitive conclusions as to whether OWHTO can be indicated in such patients without harmful effects.
膝关节早期骨关节炎大多影响内侧间室，因此截骨术是减缓疾病进展的合理方法。然而，一些患者在外侧或髌股间室表现出无症状的轻度退变。
根据外侧或髌股间室退变改变的术前状态评估无症状轻度外侧或髌股间室退变对内侧开放楔形高位胫骨截骨术（OWHTO）疗效的影响。
队列研究；证据等级，3级。
回顾性纳入114例（121膝）接受双平面OWHTO及二次关节镜检查手术和术后磁共振成像（MRI）的患者。根据国际骨关节炎研究学会（OARSI）和MRI骨关节炎膝关节评分（MOAKS）分类系统将患者分为4组。采用国际软骨修复协会（ICRS）分级评估术前和术后软骨状态。通过美国膝关节协会（AKS）评分、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）以及36项简明健康调查（SF-36）评估临床疗效。
51.2%的病例（62膝）未发现膝关节外侧和髌股间室的退变改变（I组）。15.7%的病例（19膝）仅发现外侧间室无症状性退变改变（II组：OARSI 1-3级和MOAKS 1-3级），10.7%的病例（13膝）仅发现髌股间室退变改变（III组：OARSI 1-3级和MOAKS 1-3级），22.3%的病例（27膝）发现外侧和髌股间室均有退变改变（IV组）。在内侧间室，所有组间MOAKS和ICRS分级的改善情况无显著差异（分别为P = 0.813和0.985）。在外侧和髌股间室，所有组间MOAKS（分别为P = 0.649和0.421）和ICRS分级（分别为P = 0.927和0.676）的下降情况无显著差异。
轻度外侧或髌股间室退变改变的存在不影响OWHTO的MRI、关节镜及临床疗效。然而，对于此类患者实施OWHTO是否无害，仍需长期观察才能得出确切结论。
