Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany.
Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
Knee Surg Sports Traumatol Arthrosc. 2024 Jul;32(7):1785-1797. doi: 10.1002/ksa.12213. Epub 2024 Apr 26.
To compare the clinical and radiological outcome of open-wedge high tibial osteotomy (OWHTO) with allogenous bone chips to a control group without bone void filler. The focus was on the rates and timelines of return to work (RTW) and return to sports (RTS), given the significance of these factors for the satisfaction of young and active patients.
One hundred and ninety-five cases of OWHTO (112 cases with allograft vs. 83 cases without graft) with a follow-up of 17 ± 4.8 months were included in this retrospective analysis. Various metrics were investigated, including time to return to full weight bearing, RTW and RTS rates and timelines, International Knee Documentation Committee (IKDC) Score, Cincinnati-Sportsmedicine and Orthopaedic Centre Score and Tegner Score. The time to bone union was determined on radiographs taken at 6, 16, 28 and 53 weeks.
Patients returned to full weight bearing after 8.8 ± 4.8 weeks. RTW was possible for 92.8% after 13.7 ± 12.3 weeks. 96.2% returned to sports after 22.7 ± 8.3 weeks, but the number of disciplines and workouts per week diminished (p < 0.001, p = 0.006). A shift to low-impact and recreational sports was observed. Patients with allograft filling had earlier bone union (21 ± 12.3 vs. 31.9 ± 14.2 weeks, p < 0.001) and returned faster to full weight bearing (8.2 ± 4.5 vs. 9.8 ± 5 weeks, p = 0.013). There was no difference between groups in the IKDC Score (69 ± 17.2 vs. 69.9 ± 15.2, p = 0.834), Cincinnati-Sportsmedicine and Orthopaedic Centre Score (68 ± 18.3 vs. 69.4 ± 18.2, p = 0.698) and Tegner Score (3.8 ± 1.5 vs. 4 ± 1.5, p = 0.246).
Allograft filling leads to faster bone union and return to full weight bearing but showed no significant advantage in terms of RTW/RTS, overall patient satisfaction and functional scores. The decision for or against filling the osteotomy gap, therefore, remains a case-by-case decision.
Level III, Retrospective cohort study.
比较开放式楔形胫骨高位截骨术（OWHTO）联合同种异体骨与不使用骨填充物的对照组的临床和影像学结果。鉴于这些因素对年轻活跃患者的满意度具有重要意义，我们关注的重点是恢复工作（RTW）和恢复运动（RTS）的比率和时间。
对 195 例接受 OWHTO 治疗的患者（112 例使用同种异体骨，83 例未使用骨）进行回顾性分析，随访时间为 17±4.8 个月。我们研究了多种指标，包括完全负重的时间、RTW 和 RTS 的比率和时间、国际膝关节文献委员会（IKDC）评分、辛辛那提运动医学和矫形中心评分（Cincinnati-Sportsmedicine and Orthopaedic Centre Score）和 Tegner 评分。在术后 6、16、28 和 53 周拍摄的 X 光片上确定骨愈合时间。
患者在 8.8±4.8 周后可完全负重，13.7±12.3 周后 92.8%的患者可恢复工作，22.7±8.3 周后 96.2%的患者可恢复运动，但每周的运动项目和运动量减少（p<0.001，p=0.006）。观察到运动类型向低冲击性和娱乐性运动转变。使用同种异体骨填充的患者骨愈合更早（21±12.3 周 vs. 31.9±14.2 周，p<0.001），更快地恢复完全负重（8.2±4.5 周 vs. 9.8±5 周，p=0.013）。两组之间 IKDC 评分（69±17.2 分 vs. 69.9±15.2 分，p=0.834）、Cincinnati-Sportsmedicine and Orthopaedic Centre 评分（68±18.3 分 vs. 69.4±18.2 分，p=0.698）和 Tegner 评分（3.8±1.5 分 vs. 4±1.5 分，p=0.246）无差异。
同种异体骨填充可导致更快的骨愈合和完全负重，但在 RTW/RTS、总体患者满意度和功能评分方面没有显著优势。因此，是否填充截骨间隙仍然是一个具体情况具体分析的决定。
III 级，回顾性队列研究。
