Clinical Outcomes Of High Tibial Osteotomy With Bone Marrow Stimulation Techniques In Knee Osteoarthritis: A Systematic Review

Clinical Outcomes Of High Tibial Osteotomy With Bone Marrow Stimulation Techniques In Knee Osteoarthritis: A Systematic Review

Ashton Tan, MBBS, SINGAPORE Shaun Chua , MD, SINGAPORE Don Koh, MBBS, BSc, MRCS, MMED, SINGAPORE Junwei Soong, MBBS, MRCS (Edin), MMED (Ortho), FRCS (Edin), SINGAPORE Kong Hwee Lee, MBBS, FRCS (Ortho), SINGAPORE Hamid Rahmatullah Bin Abd Razak, MBBS, FRCSEd (Ortho), FRCSGlasg (Tr & Orth), FAMS, SINGAPORE

Singapore General Hospital , Singapore, SINGAPORE


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Anatomic Location

Diagnosis / Condition

Anatomic Structure

Sports Medicine


Summary: An up-to-date summary of the clinical outcomes associated with HTO combined with BMST in patients with knee osteoarthritis.


Background

The clinical outcomes of High Tibial Osteotomy (HTO) combined with Bone Marrow Stimulation Techniques (BMST) (microfracture, subchondral drilling, microdrilling, abrasion arthroplasty) in patients with knee osteoarthritis is unclear. The aim of this systematic review was to present an up-to-date summary of the clinical outcomes associated with HTO combined with BMST in patients with knee osteoarthritis.

Methods

A systematic database search of PubMed, Embase, Web of Science and CINAHL was performed from inception up to 3 March 2024 in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). A narrative synthesis was undertaken to complement the quantitative analysis done.

Results

11 studies involving 516 patients were included. There were six reporting HTO with microfracture (MF), one reporting HTO with subchondral drilling (SD), two reporting HTO with microdrilling (MD), one reporting HTO with abrasion arthroplasty (AA) and one reporting HTO with chondral surfacing. The average mean follow up period was 33 months, ranging from 12 to 120 months. Overall, most of the studies showed an improvement in the reported clinical scores above the minimal clinically important difference (MCID).

Conclusion

HTO with BMST has good clinical outcomes post operatively. However, more comparative studies are needed in order to come to more definite conclusions on whether we should recommend HTO with BMST over an isolated HTO in the clinical setting.