Summary: Arthroscopic microdrilling for troclear cartilage defects in patients undergoing medial open-wedge high tibial osteotomy achieved favorable cartilage regeneration, especially for defect sizes <3 cm2. The 3D-measured tibial tubercle-trochlear groove distance was maintained after medial open-wedge high tibial osteotomy and was associated with decreased distal femur-distal tibial rotation.

Objective

To assess clinical outcomes and cartilage regeneration following additional arthroscopic marrow stimulation for troclear cartilage defects (TCDs) during medial open-wedge high tibial osteotomy (MOWHTO) and analyze perioperative patellofemoral biomechanics changes using three-dimensional (3D) measurements.

Methods

Thirty-eight patients (38 knees) who underwent arthroscopic marrow stimulation for TCDs combined with MOWHTO were retrospectively reviewed. The mean follow-up period was 27.0 months. Clinical assessments were performed using patient-reported outcomes. Magnetic resonance imaging and second-look arthroscopy were used to assess cartilage regeneration. The 3D measurements of parameters associated with patellar biomechanics were performed.

Results

Arthroscopic marrow stimulation for TCDs showed favorable cartilage regeneration, especially for the microdrilling group (median MOCART score, 70; success rate, 82.8% on second-look arthroscopy). In the microdrilling group, the failure group showed a significantly larger cartilage defect size than the success group (3.7±1.1 cm2 vs. 2.5±1.1 cm2; p=0.016). A defect size of 2.85 cm2 was suggested as the cut-off value to predict the failure (area under the curve, 0.838; p=0.019). In 3D measurements, the tibial tubercle-trochlear groove (TT-TG) distance was maintained (mean difference: -0.6 mm, p=0.227), whereas the modified Q-angle significantly decreased (mean difference: -1.9°, p=0.002). The distal femur-distal tibial rotation (DF-DTR) decreased, indicating internal rotation of the distal tibia (mean difference: -5.3°, p<0.001). TT-TG distance was associated with DF-DTR (r=0.583, p=0.001).

Conclusion

Arthroscopic microdrilling for TCDs in patients undergoing MOWHTO achieved favorable cartilage regeneration, especially for defect sizes <3 cm2. The 3D-measured TT-TG distance was maintained after MOWHTO and was associated with decreased DF-DTR.

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Trochlear Cartilage Regeration After Arthroscopic Marrow Stimulation Combined With High Tibial Osteotomy And 3-Dimensionally Measured Patellofemoral Biomechanical Parameters

Trochlear Cartilage Regeration After Arthroscopic Marrow Stimulation Combined With High Tibial Osteotomy And 3-Dimensionally Measured Patellofemoral Biomechanical Parameters

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Trochlear Cartilage Regeration After Arthroscopic Marrow Stimulation Combined With High Tibial Osteotomy And 3-Dimensionally Measured Patellofemoral Biomechanical Parameters

Trochlear Cartilage Regeration After Arthroscopic Marrow Stimulation Combined With High Tibial Osteotomy And 3-Dimensionally Measured Patellofemoral Biomechanical Parameters

Objective

Methods

Results

Conclusion