Survival and clinical outcome of isolated high tibial osteotomy and combined biological knee reconstruction

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• 作者：Joshua D. Harris^d ; Ryan McNeilan^a ; ^b ; Robert A. Siston^a ; ^b ; ^c ; David C. Flanigan^a ; ^b ; ^{david.flanigan@osumc.edu}
• 关键词：High tibial osteotomy ; Wedge techniques ; Articular cartilage surgery ; Meniscal allograft transplantation
• 刊名：The Knee
• 出版年：2013
• 出版时间：June, 2013
• 年：2013
• 卷：20
• 期：3
• 页码：154-161
• 全文大小：297 K

文摘

Purpose

We sought to determine survival and clinical outcomes of high tibial osteotomy (HTO) with or without articular cartilage surgery and/or meniscal allograft transplantation in patients with medial compartment chondral pathology, varus malalignment, and/or meniscal deficiency, whether there is any difference in survival or clinical outcome between these patient cohorts, and whether there is any difference between opening- (OWHTO) and closing-wedge (CWHTO) techniques.

Methods

A systematic review of multiple medical databases was performed using PRISMA guidelines. Study quality was assessed via modified Coleman Methodology Scores (MCMS).

Results

Sixty-nine studies were included (4557 subjects). MCMS rating was overall poor. Mean follow-up was 7.1 years. Mean subject age was 53 years. Survival of isolated HTO was 92.4 % , 84.5 % , 77.3 % , and 72.3 % at 5, 10, 15, and 20 years of follow-up. At 5 years of follow-up, HTO with articular cartilage surgery had significantly greater survival (97.7 % ) than either isolated HTO (92.4 % ) or HTO with MAT (90.9 % ). Isolated HTO, HTO with articular cartilage surgery, and HTO with MAT all significantly improved subjective and objective clinical outcome scores. At two years of follow-up, survival was significantly greater following OWHTO (98.7 % ) versus CWHTO (96.7 % ). However, at all other time points with or without combined articular cartilage surgery and/or MAT, there was no significant survival difference between the techniques.

Conclusions

Survival and clinical outcomes of isolated HTO were excellent at short- and mid-term follow-ups, but deteriorated with time. HTO with concomitant procedures also demonstrated excellent early survival and clinical outcomes that deteriorated with time (up to 10 years).