Combined high tibial osteotomy and osteochondral autograft transplantation for medial osteoarthritis with concomitant lateral femoral condyle cartilage lesions: A retrospective study.

BACKGROUND

Open-wedge high tibial osteotomy (OWHTO) is traditionally avoided in varus knees with medial osteoarthritis when accompanied by concomitant lateral femoral condyle (LFC) cartilage lesions, due to concerns about overloading the lateral compartment. This study aimed to evaluate the clinical outcomes of OWHTO combined with osteochondral autograft transplantation (OAT) in patients with such bicompartmental involvement.

METHODS

We retrospectively reviewed 30 patients (30 knees) with varus knee osteoarthritis and LFC cartilage lesions who underwent OWHTO with concomitant OAT between January 2015 and December 2020. Radiographic assessments included the %mechanical axis (%MA) , hip-knee-ankle (HKA) angle, and joint line convergence angle (JLCA). Clinical outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales. Second-look arthroscopy evaluated cartilage repair at 12 months postoperatively.

RESULTS

All radiographic parameters significantly improved postoperatively. The mean %MA changed from 36 % preoperatively to 66 % postoperatively (P < 0.001). The HKA angle corrected from -7.2° to 1.6° (P < 0.001). KOOS subscale scores for pain, symptoms, activities of daily living, sports and recreation, and quality of life all significantly improved (P < 0.001). Second-look arthroscopy revealed cartilage repair classified as ICRS-CRA Grade 1 or 2 in the majority of cases.

CONCLUSION

Combining OWHTO with OAT was associated with significant clinical and radiographic improvements in patients with medial osteoarthritis accompanied by concomitant LFC cartilage lesions. This joint-preserving approach may offer a treatment option for selected patients with bicompartmental cartilage involvement, although further studies are needed to assess long-term outcomes.