软骨再生与开放式楔形胫骨高位截骨术后患者中期的优良报告结果相关。
Cartilage regeneration is related to superior mid-term patient-reported outcomes after open-wedge high tibial osteotomy.
机构信息
Department of Orthopaedic Surgery, Hirosaki University, Graduate School of Medicine, Hirosaki, Japan.
Department of Rehabilitation Medicine, Hirosaki University, Graduate School of Medicine, Hirosaki, Japan.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2024 Mar;32(3):725-735. doi: 10.1002/ksa.12091. Epub 2024 Feb 27.
PURPOSE
Medial open-wedge high tibial osteotomy (OWHTO) is related to cartilage improvement in the medial compartment. This study aimed to evaluate factors associated with cartilage improvement and patient-reported outcomes (PRO) after OWHTO. It was hypothesised that cartilage improvement is associated with favourable PRO.
METHODS
This retrospective study included 94 patients who underwent OWHTO. The mean follow-up period was 5 years. The weight-bearing line ratio (WBLR) was defined as the ratio of the distance from the medial tibial edge to the tibial insertion of the weight-bearing line and the tibial width. The International Cartilage Research Society grade evaluated the medial femoral condyle (MFC) and medial tibial plateau (MTP) at initial and second-look arthroscopy, and cartilage improvement after OWHTO was assessed. Postoperative knee injury and osteoarthritis outcome scores (KOOS) were compared between the groups with improved and non-improved cartilage. Additionally, factors related to cartilage improvement and postoperative KOOS scores were analysed.
RESULTS
Regarding the MFC, KOOS pain, symptoms, activities of daily living (ADL) and quality of life (QOL) were significantly higher in the cartilage-improved group than in the non-improved group (p = 0.012, 0.003, 0.001, 0.006), and cartilage improvement was significantly related to KOOS pain, ADL and QOL (p = 0.021, 0.039, 0.013). In addition, the postoperative WBLR was associated with cartilage improvement, with a cutoff value of 54.0% (p = 0.046). Regarding the MTP, KOOS ADL and QOL (p = 0.026, 0.022) were significantly higher in the cartilage-improved group than in the nonimproved group. Body mass index (BMI) was significantly related to the postoperative QOL (p = 0.018) and associated with cartilage improvement, with a cutoff value of 25.9 kg/m (p = 0.002).
CONCLUSION
A postoperative WBLR greater than 54.0% and a preoperative BMI below 25.9 kg/m were associated with cartilage improvement, positively impacting PRO after OWHTO.
LEVEL OF EVIDENCE
Level III, retrospective comparative study.
目的
内侧开放楔形胫骨高位截骨术（OWHTO）与内侧间室软骨改善有关。本研究旨在评估 OWHTO 后与软骨改善和患者报告的结果（PRO）相关的因素。研究假设软骨改善与良好的 PRO 相关。
方法
本回顾性研究纳入了 94 例行 OWHTO 的患者。平均随访时间为 5 年。负重线比值（WBLR）定义为从内侧胫骨边缘到负重线胫骨插入点的距离与胫骨宽度的比值。国际软骨研究协会（ICRS）分级在初次和二次关节镜检查时评估内侧股骨髁（MFC）和内侧胫骨平台（MTP），并评估 OWHTO 后的软骨改善情况。比较软骨改善组和无改善组之间术后膝关节损伤和骨关节炎结果评分（KOOS）的差异。此外，还分析了与软骨改善和术后 KOOS 评分相关的因素。
结果
在 MFC 方面，软骨改善组的 KOOS 疼痛、症状、日常生活活动（ADL）和生活质量（QOL）评分均明显高于无改善组（p=0.012、0.003、0.001、0.006），软骨改善与 KOOS 疼痛、ADL 和 QOL 显著相关（p=0.021、0.039、0.013）。此外，术后 WBLR 与软骨改善相关，截取值为 54.0%（p=0.046）。在 MTP 方面，软骨改善组的 KOOS-ADL 和 QOL 评分明显高于无改善组（p=0.026、0.022）。体重指数（BMI）与术后 QOL 显著相关（p=0.018），并与软骨改善相关，截取值为 25.9kg/m²（p=0.002）。
结论
术后 WBLR 大于 54.0%和术前 BMI 小于 25.9kg/m²与软骨改善相关，OWHTO 后 PRO 得到改善。
证据等级
三级，回顾性比较研究。
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