2017 ISAKOS Biennial Congress Paper #161

Second Look Arthroscopic Evaluation of the Cartilage Regeneration After High Tibial Osteotomy With and Without Microfracture Procedure in Patients with Grade 3 Medial Femoral Cartilage Lesion

Sang-Jin Park, MD, Gwangju KOREA, REPUBLIC OF
Jae Yoon Chung, MD, PhD, Gwang ju KOREA, REPUBLIC OF

Segyero hospital, Gwang ju, KOREA, REPUBLIC OF

FDA Status Not Applicable

Summary

Compared to cartilage regeneration in isolated HTO surgery, cartilage regeneration was achieved more satisfactory with microfracture procedure in HTO surgery performed in patients with ICRS grade 3 degenerated medial femoral cartilages. However there is no significant difference in clinical outcomes.

Abstract

Purpose

The purposes of this study were to compare the results of high tibial osteotomy(HTO) with and without microfracture procedure for ICRS grade 3 osteoarthritic knees and to assess the degree of cartilage regeneration at second look arthroscopic surgery.

Material & method
From December, 2011 to March 2016, 201 patients who underwent a second-look arthroscopic evaluation at the time of surgery of plate removal after 1 year of initial HTO were involved.
Only ICRS grade 3 of medial femoral cartilage at the time of initial HTO surgery were included in this study. HTO without any cartilage repair procedure group included 36 patients and HTO with microfracture procedure included in 29 patients.
Cartilage status of initial arthroscopy and second arthroscopy were evaluated using the International Cartilage repair society (ICRS) grading system. For microfracture group, overall chondral condition was reclassified as sum of surrounding and repaired chondral condition. If surround cartilage is normal (Gr 0) and grade of ICRS repaired cartilage is normal (Gr 1), overall grade was defined grade 0. If surrounding cartilage is abnormal (Gr1-Gr4), overall grade was adopted as the higher grade compared to ICRS repaired cartilage grade. KS score and mechanical tibiofemoral angle at the time of second look surgery was assessed for clinical and radiological outcomes.

Results

There is no difference between two groups in sex, age, BMI, preoperative varus deformity, operation method (open HTO vs closing HTO) and postoperative mechanical axis.
Clinically both group had a satisfactory results. ( KS sore 95.3 vs 94.6)
ICRS grade of medial femoral condyle was improved significantly in microfracture group (mean ICRS grade 1.86).
Of the 29 knee with grade 3 at initial operation, 10 (34.5 %) improved to grade 1, 13 (44.8%) improved to grade 2 and 6 (20.7%) showed no regenerative change.
ICRS grade of medial femoral condyle showed no significant difference in isolated HTO group( mean ICRS grade 2.54).
Of the 36 knee with grade 3 at initial operation, 3 (8.3 %) improved to grade 1, 11 (30.6%) improved to grade 2, 21 (58.3%) showed no regenerative change and 1 (2.8 %) aggravated to grade 4.

Conclusion

Compared to cartilage regeneration in isolated HTO surgery, cartilage regeneration was achieved more satisfactory with microfracture procedure in HTO surgery performed in patients with ICRS grade 3 degenerated medial femoral cartilages. However there is no significant difference in clinical outcomes.