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Cartilage Repair of the Tibiofemoral Joint with Versus Without Concomitant Osteotomy: A Systematic Review of Clinical Outcomes

Matthew J. Kraeutler, MD
UNITED STATES

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Cartilage Repair of the Tibiofemoral Joint with Versus Without Concomitant Osteotomy: A Systematic Review of Clinical Outcomes

Jaydeep Dhillon, BS, UNITED STATES Matthew J. Kraeutler, MD, UNITED STATES Sydney M Fasulo, MD, UNITED STATES Mary K. Mulcahey, MD, UNITED STATES Anthony Scillia, UNITED STATES Patrick C. McCulloch, MD, UNITED STATES

Rocky Vista University College of Osteopathic Medicine, Parker, CO, UNITED STATES

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Anatomic Location

Knee

Anatomic Structure

Cartilage

Treatment / Technique

Osteotomy Allograft

Cartilage

Cartilage Treatment Cartilage Injuries

Summary: Surgeons preparing for cartilage procedures of the knee joint should pay particular attention to preoperative malalignment of the lower extremity in order to optimize outcomes.

Purpose

The purpose of this study was to perform a systematic review to compare clinical outcomes of patients undergoing cartilage repair of the tibiofemoral joint with versus without concomitant osteotomy.

Methods

A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by searching PubMed, the Cochrane Library, and Embase to identify comparative studies directly comparing outcomes between cartilage repair of the tibiofemoral joint alone versus cartilage repair with concomitant osteotomy (high tibial osteotomy [HTO] or distal femoral osteotomy [DFO]). Studies on cartilage repair of the patellofemoral joint were excluded. The search terms used were: osteotomy AND knee AND (“autologous chondrocyte” OR “osteochondral autograft” OR “osteochondral allograft” OR microfracture). Patients were evaluated based on reoperation rate, complication rate, procedure payments, and patient-reported outcomes (the Knee Injury and Osteoarthritis Outcome Score [KOOS], the Visual Analog Scale [VAS] for pain, and satisfaction).

Results

Five studies (1 Level II, 2 Level III, 2 Level IV) met inclusion criteria, including a total of 1,747 patients undergoing cartilage repair alone (Group A) and 520 patients undergoing cartilage repair with concomitant osteotomy (Group B). Mean patient age was 34.7 and 37.5 years in Groups A and Group B, respectively, and the mean lesion size was 4.0 and 4.5 cm2 in Groups A and B, respectively. The mean follow-up time was 44.6 months. The most common lesion location was the medial femoral condyle (n=999). The two most common cartilage procedures were autologous chondrocyte implantation (n=883) and osteochondral allograft implantation (n=765). Preoperative alignment averaged 1.8 and 5.5 degrees of varus in Groups A and B, respectively. One study found significant differences in KOOS, VAS, and satisfaction favoring Group B. Groups A and B had an overall reoperation rate of 47.4% and 17.3%, respectively (p<0.0001). One study found no significant differences in complication rate and procedure payments between groups (p>0.05).

Conclusion

Patients undergoing cartilage repair of the tibiofemoral joint with concomitant osteotomy might be expected to experience greater improvement in clinical outcomes with a lower reoperation rate compared to cartilage repair alone. Surgeons preparing for cartilage procedures of the knee joint should pay particular attention to preoperative malalignment of the lower extremity in order to optimize outcomes.

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Cartilage Repair of the Tibiofemoral Joint with Versus Without Concomitant Osteotomy: A Systematic Review of Clinical Outcomes

Cartilage Repair of the Tibiofemoral Joint with Versus Without Concomitant Osteotomy: A Systematic Review of Clinical Outcomes

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Cartilage Repair of the Tibiofemoral Joint with Versus Without Concomitant Osteotomy: A Systematic Review of Clinical Outcomes

Cartilage Repair of the Tibiofemoral Joint with Versus Without Concomitant Osteotomy: A Systematic Review of Clinical Outcomes

Purpose

Methods

Results

Conclusion

More 2023 ISAKOS Congress Content