Ghasemi S Ali, Kolesnick Evan, Murray Benjamin C, Leiby Benjamin E, Bartolozzi Arthur R, Zaslav Kenneth R
Department of Orthopaedic Surgery, Albert Einstein Health Network, 5501 Old York Road, Philadelphia, PA, 19141, USA.
Philadelphia College of Osteopathic Medicine, 4170 City Ave, Philadelphia, PA, 19131, USA.
J Clin Orthop Trauma. 2024 Feb 6;50:102360. doi: 10.1016/j.jcot.2024.102360. eCollection 2024 Mar.
Focal chondral defects are often treated with cartilage restoration procedures. Malalignment often accompanies chondral defects. High tibial osteotomy (HTO), classically utilized to treat uni-compartmental knee osteoarthritis, corrects malalignment. HTO combined with cartilage restoration procedures can treat uni-compartmental osteoarthritis and focal chondral defects.
To assess outcomes of combined HTO and cartilage restoration procedures and review prognostic factors that may assist in preoperative planning and patient counseling.
Systematic Review of published literature.
A systematic review of PubMed and Scopus was performed following PRISMA guidelines. Thirty-four papers were included in qualitative considerations.
Thirty-four papers that reported the combined outcome of HTO and cartilage repair were included. Twenty of the 34 included papers reported prognostic factors that affected the success or failure of combined HTO and cartilage repair surgery for focal articular defect and uni-compartmental knee osteoarthritis. Cartilage repair techniques that were combined with HTO and included in this review are bone marrow stimulation, allograft transplantation, osteochondral autograft transplantation, autologous chondrocyte implantation, and mesenchymal stem cell implantation.
HTO with adjunctive cartilage repair procedures improve clinical outcome scores and restore alignment in patients with medial compartment osteoarthritis and isolated focal chondral defects. HTO with adjunctive cartilage procedures produces optimal results in younger, non-obese patients with focal chondral defects and varus malalignment, without significant lateral compartment and patellofemoral involvement.
局灶性软骨缺损通常采用软骨修复手术治疗。软骨缺损常伴有对线不良。经典的用于治疗单髁膝关节骨关节炎的高位胫骨截骨术（HTO）可纠正对线不良。HTO联合软骨修复手术可治疗单髁骨关节炎和局灶性软骨缺损。
评估HTO与软骨修复手术联合应用的疗效，并回顾可能有助于术前规划和患者咨询的预后因素。
对已发表文献的系统评价。
按照PRISMA指南对PubMed和Scopus进行系统评价。34篇论文纳入定性分析。
纳入34篇报告HTO与软骨修复联合疗效的论文。34篇纳入论文中有20篇报告了影响HTO与软骨修复联合手术治疗局灶性关节缺损和单髁膝关节骨关节炎成败的预后因素。本综述纳入的与HTO联合应用的软骨修复技术包括骨髓刺激、同种异体移植、自体骨软骨移植、自体软骨细胞植入和间充质干细胞植入。
HTO联合辅助软骨修复手术可改善内侧间室骨关节炎和孤立性局灶性软骨缺损患者的临床疗效评分并恢复对线。HTO联合辅助软骨手术在年轻、非肥胖、有局灶性软骨缺损和内翻对线不良且无明显外侧间室和髌股关节受累的患者中可产生最佳效果。
