Improved clinical outcome after medial open-wedge osteotomy despite cartilage lesions in the lateral compartment


Autoři: Lisa Hohloch aff001;  Suchung Kim aff002;  Helge Eberbach aff001;  Kaywan Izadpanah aff001;  Julian Mehl aff003;  Philipp Niemeyer aff001;  Norbert P. Südkamp aff001;  Gerrit Bode aff001
Působiště autorů: Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany aff001;  Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Berlin, Germany aff002;  Department of Orthopaedic Sports Medicine, Hospital Rechts der Isar, Technical University of Munich, Munich, Germany aff003;  OCM Orthopädische Chirurgie München, Munich, Germany aff004
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224080

Souhrn

High tibial medial open-wedge osteotomy (HTO) is an established treatment option for cartilage lesions in the medial compartment. It was this study’s aim to evaluate the effect of asymptomatic single or kissing lesions in the lateral compartment on functional outcome after medial open-wedge osteotomy. A total of 156 patients were enrolled in this retrospective study. All patients underwent HTO due to a varus deformity and a symptomatic cartilage lesion or osteoarthritis in the medial compartment. We acquired preoperative Lysholm and VAS Scores. Each open-wedge osteotomy was preceded by diagnostic arthroscopy to ensure the compartments were thoroughly documented and diagnosed. Cartilage lesions in the lateral compartment were evaluated, and three groups created according to their individual characteristics: group A (no cartilage lesion, n = 119), group B (single cartilage lesion, n = 16) and group C (kissing lesions, n = 21). Cartilage lesions were graded according to the Outerbridge classification, The functional postoperative outcome was determined by relying on several parameters (VAS Score, Lysholm, KOOS, WOMAC Score). Pre- and postoperative long-leg axis views were analyzed via special planning software (mediCAD, Hectec GmbH Germany). Mean follow-up was at 69.0 ± 30.3 months after surgery (range 22 to 121 months). There were no significant differences between the three groups in the correction angle chosen (p = 0.16). Regarding the outcome parameters, group A attained the best results in the WOMACpain Score (p = 0.03) and WOMACfunction Score (p = 0.05). A higher Outerbridge-Score of cartilage lesions in the lateral compartment was associated with a higher (i.e., worse) WOMACpain Score (p = 0.018) and WOMACfunction Score (p = 0.033). In all the groups (A, B, and C), HTO led to a significant improvement in the Lysholm Score (p < 0.001) and to a decrease in pain level (VAS Score; p < 0.001). Conclusion: Valgus high tibial osteotomy leads to reduced pain and improved functional outcome scores, even in patients with pre-existing asymptomatic single or corresponding cartilage lesions in the lateral compartment. In case of severe cartilage lesions in the lateral compartment, surgeons should consider that clinical outcome worsens depending on the Outerbridge Score.

Klíčová slova:

Cartilage – Knees – Lesions – Osteoarthritis – Sheep – Surgical and invasive medical procedures – Wound healing – Arthroscopy


Zdroje

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Článek vyšel v časopise

PLOS One


2019 Číslo 10