Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, South Korea.
Bone Joint J. 2021 Nov;103-B(11):1686-1694. doi: 10.1302/0301-620X.103B11.BJJ-2020-2130.R2.
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.
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.
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).
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: 2021;103-B(11):1686-1694.
在中期随访时，确定内侧开放楔形胫骨高位截骨术（MOHTO）治疗内侧间室膝关节骨关节炎后关节软骨状况与临床结果之间的关系。
我们回顾了 2008 年 1 月至 2016 年 12 月期间接受 MOHTO 治疗的 155 例患者（155 膝），平均随访 5.3 年（2.0 至 11.7 年）。根据国际软骨修复协会（ICRS）软骨修复评估（CRA）分级系统评估关节镜检查结果。根据内侧股骨髁软骨存在正常或近乎正常质量的情况，将患者分为两组：良好（关节镜下）状态（ICRS 分级 I 或 II；n = 70）和较差（关节镜下）状态（ICRS 分级 III 或 IV；n = 85）组。使用国际膝关节文献委员会（IKDC）评分、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）和 36 项简短表格调查评估临床结果。
两组患者的所有临床评估指标在术前和关节镜下二次评估之间均有显著改善（p < 0.001）。在末次随访时，与关节镜下二次评估时相比，良好状态组的 IKDC 和 WOMAC 评分进一步改善（p < 0.001），而较差状态组则没有。末次随访时，两组间 IKDC 评分的差异有统计学意义（良好状态组，72.8（SD 12.5）；较差状态组，64.7（SD 12.1）；p = 0.002）和 WOMAC 评分（良好状态组，15.7（SD 10.8）；较差状态组，21.8（SD 13.6）；p = 0.004）。此外，在末次随访时，还观察到 ICRS CRA 分级与 IKDC 评分（负相关；p < 0.001）和 WOMAC 评分（正相关；p < 0.001）之间存在显著相关性。与矫正范围在 2°至 6°之间的膝关节相比，在矫正范围之外的膝关节中，软骨状态良好的膝关节更常见（p = 0.019）。
尽管两组之间的临床差异相对较小，但在中期随访时，关节镜下的二次软骨状态与 MOHTO 后的临床结果相关。
