Jung Se-Han, Jung Min, Chung Kwangho, Moon Hyun-Soo, Kim Tae Hyun, Choi Chong-Hyuk, Kim Sung-Hwan
Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Clin Orthop Surg. 2025 Aug;17(4):607-621. doi: 10.4055/cios24409. Epub 2025 Jul 15.
BACKGROUND: The clinical benefits of combining cartilage procedures with high tibial osteotomy (HTO) remain undetermined. This study aimed to evaluate the additional clinical benefits by comparing a combined procedure group with an isolated HTO group, with stratification based on the success of cartilage regeneration. METHODS: Patients who underwent medial open-wedge HTO from 2010 to 2022 with a minimum 2-year follow-up were retrospectively reviewed. Patients were divided into 2 groups: HTO + combined cartilage procedures (C group) and isolated HTO (I group). C group was further divided into 2 subgroups based on the medial femoral condyle (MFC) cartilage status assessed on second-look arthroscopy: well-regenerated cartilage (C1 group) and poorly regenerated cartilage (C2 group). Propensity score-matched I groups were formed for each C1 and C2 group (C1-matched and C2-matched group I), based on baseline factors affecting clinical outcomes. Comparative analysis was performed for each matched pair based on patient-reported outcomes (PROs). RESULTS: A total of 313 patients were retrospectively reviewed in this study, with 199 patients included in the analysis: 83 patients in the C group (49 in the C1 group and 34 in the C2 group) and 116 patients in the I group. Baseline characteristics showed no significant difference between the matched groups after propensity score matching. The mean follow-up period for all groups was approximately 3 years with no significant differences. The C1 group showed significantly better PROs and improved PROs at the final follow-up compared to the C1-matched I group (visual analog scale score, < 0.001; Lysholm, = 0.004; Knee injury and Osteoarthritis Outcome Score subscales, ≤ 0.018). However, the C2 group did not show any differences in PROs compared to the C2-matched I group at the final follow-up. CONCLUSIONS: Only patients with well-regenerated cartilage after combined cartilage repair procedures showed additional clinical outcome improvements with HTO. When considering combined cartilage repair procedures with HTO, selecting appropriate candidates for achieving successful cartilage regeneration is necessary to yield additional clinical benefits.
背景：将软骨修复手术与高位胫骨截骨术（HTO）相结合的临床益处尚未确定。本研究旨在通过比较联合手术组和单纯HTO组，并根据软骨再生的成功情况进行分层，来评估额外的临床益处。 方法：对2010年至2022年接受内侧开放楔形HTO且随访至少2年的患者进行回顾性研究。患者分为两组：HTO + 联合软骨修复手术组（C组）和单纯HTO组（I组）。C组根据二次关节镜检查评估的股骨内侧髁（MFC）软骨状态进一步分为两个亚组：软骨再生良好组（C1组）和软骨再生不良组（C2组）。根据影响临床结果的基线因素，为每个C1组和C2组形成倾向评分匹配的I组（C1匹配组和C2匹配组I）。基于患者报告的结果（PROs）对每个匹配对进行比较分析。 结果：本研究共回顾性分析了313例患者，其中199例纳入分析：C组83例（C1组49例，C2组34例），I组116例。倾向评分匹配后，匹配组间的基线特征无显著差异。所有组的平均随访期约为3年，无显著差异。与C1匹配的I组相比，C1组在最终随访时的PROs显著更好且有所改善（视觉模拟评分，<0.001；Lysholm评分，=0.004；膝关节损伤和骨关节炎结果评分量表，≤0.018）。然而，在最终随访时，C2组与C2匹配的I组相比，PROs没有任何差异。 结论：只有在联合软骨修复手术后软骨再生良好的患者，HTO才能带来额外的临床结果改善。在考虑将软骨修复手术与HTO联合应用时，选择合适的患者以实现成功的软骨再生对于获得额外的临床益处是必要的。
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