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Improved clinical outcome after medial open-wedge osteotomy despite cartilage lesions in the lateral compartment


Autoři: Lisa Hohloch aff001;  Suchung Kim aff002;  Helge Eberbach aff001;  Kaywan Izadpanah aff001;  Julian Mehl aff003;  Philipp Niemeyer aff001;  Norbert P. Südkamp aff001;  Gerrit Bode aff001
Působiště autorů: Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany aff001;  Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Berlin, Germany aff002;  Department of Orthopaedic Sports Medicine, Hospital Rechts der Isar, Technical University of Munich, Munich, Germany aff003;  OCM Orthopädische Chirurgie München, Munich, Germany aff004
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0224080

Souhrn

High tibial medial open-wedge osteotomy (HTO) is an established treatment option for cartilage lesions in the medial compartment. It was this study’s aim to evaluate the effect of asymptomatic single or kissing lesions in the lateral compartment on functional outcome after medial open-wedge osteotomy. A total of 156 patients were enrolled in this retrospective study. All patients underwent HTO due to a varus deformity and a symptomatic cartilage lesion or osteoarthritis in the medial compartment. We acquired preoperative Lysholm and VAS Scores. Each open-wedge osteotomy was preceded by diagnostic arthroscopy to ensure the compartments were thoroughly documented and diagnosed. Cartilage lesions in the lateral compartment were evaluated, and three groups created according to their individual characteristics: group A (no cartilage lesion, n = 119), group B (single cartilage lesion, n = 16) and group C (kissing lesions, n = 21). Cartilage lesions were graded according to the Outerbridge classification, The functional postoperative outcome was determined by relying on several parameters (VAS Score, Lysholm, KOOS, WOMAC Score). Pre- and postoperative long-leg axis views were analyzed via special planning software (mediCAD, Hectec GmbH Germany). Mean follow-up was at 69.0 ± 30.3 months after surgery (range 22 to 121 months). There were no significant differences between the three groups in the correction angle chosen (p = 0.16). Regarding the outcome parameters, group A attained the best results in the WOMACpain Score (p = 0.03) and WOMACfunction Score (p = 0.05). A higher Outerbridge-Score of cartilage lesions in the lateral compartment was associated with a higher (i.e., worse) WOMACpain Score (p = 0.018) and WOMACfunction Score (p = 0.033). In all the groups (A, B, and C), HTO led to a significant improvement in the Lysholm Score (p < 0.001) and to a decrease in pain level (VAS Score; p < 0.001). Conclusion: Valgus high tibial osteotomy leads to reduced pain and improved functional outcome scores, even in patients with pre-existing asymptomatic single or corresponding cartilage lesions in the lateral compartment. In case of severe cartilage lesions in the lateral compartment, surgeons should consider that clinical outcome worsens depending on the Outerbridge Score.

Klíčová slova:

Surgical and invasive medical procedures – Cartilage – Lesions – Wound healing – Osteoarthritis – Knees – Sheep – Arthroscopy


Zdroje

1. Lobenhoffer P, Agneskirchner J, Zoch W. Die öffnende valgisierende Osteotomie der proximalen Tibia mit Fixation durch einen medialen Plattenfixateur. Orthopade. 2004 Feb 1;33(2):153–60.

2. Bode G, Heyden J, Pestka J, Schmal H, Salzmann G, Südkamp N, et al. Prospective 5-year survival rate data following open-wedge valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. Springer Berlin Heidelberg; 2015 Apr 16;:1–7.

3. Hohloch L, Kim S, Mehl J, Zwingmann J, Feucht MJ, Eberbach H, et al. Customized post-operative alignment improves clinical outcome following medial open-wedge osteotomy. Knee Surgery, Sports Traumatology, Arthroscopy. Springer Berlin Heidelberg; 2017 Oct 3;:1–8.

4. Feucht MJ, Minzlaff P, Saier T, Cotic M, Südkamp NP, Niemeyer P, et al. Degree of axis correction in valgus high tibial osteotomy: proposal of an individualised approach. International Orthopaedics (SICOT). 2014 Jul 10;38(11):2273–80.

5. Schröter S, Ateschrang A, Löwe W, Nakayama H, Stöckle U, Ihle C. Early full weight-bearing versus 6-week partial weight-bearing after open wedge high tibial osteotomy leads to earlier improvement of the clinical results: a prospective, randomised evaluation. Knee Surg Sports Traumatol Arthrosc. Springer Berlin Heidelberg; 2015 Apr 6;:1–8.

6. Madry H, Ziegler R, Orth P, Goebel L, Ong MF, Kohn D, et al. Effect of open wedge high tibial osteotomy on the lateral compartment in sheep. Part I: analysis of the lateral meniscus. Knee Surg Sports Traumatol Arthrosc. 2012 Aug 17;21(1):39–48. doi: 10.1007/s00167-012-2176-2 22898914

7. Madry H, Ziegler R, Pape D, Cucchiarini M. [Structural changes in the lateral tibiofemoral compartment after high tibial osteotomy]. Orthopade. Springer Berlin Heidelberg; 2014 Nov;43(11):958–65.

8. Ziegler R, Goebel L, Cucchiarini M, Pape D, Madry H. Effect of open wedge high tibial osteotomy on the lateral tibiofemoral compartment in sheep. Part II: standard and overcorrection do not cause articular cartilage degeneration. Knee Surg Sports Traumatol Arthrosc. Springer Berlin Heidelberg; 2014 Jul;22(7):1666–77.

9. Ziegler R, Goebel L, Seidel R, Cucchiarini M, Pape D, Madry H. Effect of open wedge high tibial osteotomy on the lateral tibiofemoral compartment in sheep. Part III: analysis of the microstructure of the subchondral bone and correlations with the articular cartilage and meniscus. Knee Surgery, Sports Traumatology, Arthroscopy. Springer Berlin Heidelberg; 2015 Aug 17;23(9):2704–14.

10. Mina C, Garrett WE, Pietrobon R, Glisson R, Higgins L. High tibial osteotomy for unloading osteochondral defects in the medial compartment of the knee. Am J Sports Med. SAGE PublicationsSage CA: Los Angeles, CA; 2008 May;36(5):949–55.

11. Spahn G, Klinger H, Harth P, Hofmann G. Knorpelregeneration nach valgisierender Tibiakopfosteotomie. Ergebnisse einer arthroskopischen Studie. Z Orthop Unfall. 2012 Jun 21;150(03):272–9.

12. Parker DA, Beatty KT, Giuffre B, Scholes CJ, Coolican MRJ. Articular Cartilage Changes in Patients With Osteoarthritis After Osteotomy. Am J Sports Med. 2011 May 5;39(5):1039–45. doi: 10.1177/0363546510392702 21285442

13. Ziegler R, Goebel L, Cucchiarini M, Pape D, Madry H. Effect of open wedge high tibial osteotomy on the lateral tibiofemoral compartment in sheep. Part II: standard and overcorrection do not cause articular cartilage degeneration. Knee Surg Sports Traumatol Arthrosc. 2013 Jan 23;22(7):1666–77. doi: 10.1007/s00167-013-2410-6 23340838

14. Outerbridge RE. The etiology of chondromalacia patellae. 1961. Clinical orthopaedics and related research. 2001. 4 p.

15. Staubli AE, De Simoni C, Babst R, Lobenhoffer P. TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia—early results in 92 cases. Injury. 2003 Nov;34 Suppl 2:B55–62.

16. Bode G, Schmal H, Pestka JM, Ogon P, Südkamp NP, Niemeyer P. A non-randomized controlled clinical trial on autologous chondrocyte implantation (ACI) in cartilage defects of the medial femoral condyle with or without high tibial osteotomy in patients with varus deformity of less than 5°. Arch Orthop Trauma Surg. 2012 Oct 30;133(1):43–9. doi: 10.1007/s00402-012-1637-x 23109095

17. S HJ PD, R JB MD, T A PD. Modification and validation of the Lysholm Knee Scale to assess articular cartilage damage. Osteoarthritis and Cartilage. Elsevier Ltd; 2009 Jan 1;17(1):53–8.

18. Roos EM, Toksvig-Larsen S. Knee injury and Osteoarthritis Outcome Score (KOOS)—validation and comparison to the WOMAC in total knee replacement. Health Qual Life Outcomes. BioMed Central; 2003 May 25;1(1):17.

19. Wolfe F, Kong SX. Rasch analysis of the Western Ontario MacMaster questionnaire (WOMAC) in 2205 patients with osteoarthritis, rheumatoid arthritis, and fibromyalgia. Annals of the Rheumatic Diseases. BMJ Publishing Group; 1999 Sep;58(9):563–8.

20. Proffen BL, McElfresh M, Fleming BC, Murray MM. A comparative anatomical study of the human knee and six animal species. The Knee. Elsevier B.V; 2012 Aug 1;19(4):493–9.

21. Thambyah A, Nather A, Goh J. Mechanical properties of articular cartilage covered by the meniscus. Osteoarthritis and Cartilage. 2006 Jun;14(6):580–8. doi: 10.1016/j.joca.2006.01.015 16621620

22. Jin C, Song E-K, Jin Q-H, Lee N-H, Seon J-K. Outcomes of simultaneous high tibial osteotomy and anterior cruciate ligament reconstruction in anterior cruciate ligament deficient knee with osteoarthritis. BMC Musculoskelet Disord. BioMed Central; 2018 Jul 18;19(1):228.

23. Na YG, Lee BK, Hwang DH, Choi ES, Sim JA. Can osteoarthritic patients with mild varus deformity be indicated for high tibial osteotomy? The Knee. 2018 Jun 19.


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PLOS One


2019 Číslo 10
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