胫骨高位截骨联合自体骨软骨移植治疗伴股骨外侧髁软骨病变的内侧骨关节炎回顾性研究

IF 2 4区医学 Q3 ORTHOPEDICS

Knee Pub Date : 2025-08-20 DOI:10.1016/j.knee.2025.07.017

Shuzo Takazawa , Yuki Kato , Ken Ichikawa , Takuya Okada , Shin Yamada , Hiroshi Ohuchi

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引用次数: 0

摘要

背景：对于伴有内侧骨关节炎的膝内翻伴股骨外侧髁（LFC）软骨病变的患者，由于担心外侧腔室超载，传统上避免开楔高位胫骨截骨术（OWHTO）。本研究旨在评价OWHTO联合自体骨软骨移植（OAT）治疗此类双室受损伤患者的临床效果。方法回顾性分析2015年1月至2020年12月30例（30膝）膝内翻骨性关节炎合并LFC软骨病变的OWHTO合并OAT患者。影像学评估包括%机械轴（%MA）、髋关节-膝关节-踝关节（HKA）角和关节线收敛角（JLCA）。临床结果采用膝关节损伤和骨关节炎结局评分（oos）亚量表进行评估。术后12个月复查关节镜评估软骨修复情况。结果术后各项影像学指标均有明显改善。平均MA从术前的36%降至术后的66% （P < 0.001）。HKA角从−7.2°修正到1.6°（P < 0.001）。疼痛、症状、日常生活活动、运动和娱乐以及生活质量的kos分量表得分均显著改善（P < 0.001）。二次关节镜检查显示，大多数病例的软骨修复分为ICRS-CRA 1级或2级。结论OWHTO联合OAT治疗内侧骨关节炎合并LFC软骨病变患者的临床和影像学有显著改善。这种关节保留方法可能为双室软骨受累的特定患者提供一种治疗选择，尽管需要进一步的研究来评估长期结果。

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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.

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来源期刊

Knee 医学-外科

CiteScore

3.80

自引率

5.30%

发文量

171

审稿时长

6 months

期刊介绍： The Knee is an international journal publishing studies on the clinical treatment and fundamental biomechanical characteristics of this joint. The aim of the journal is to provide a vehicle relevant to surgeons, biomedical engineers, imaging specialists, materials scientists, rehabilitation personnel and all those with an interest in the knee. The topics covered include, but are not limited to: • Anatomy, physiology, morphology and biochemistry; • Biomechanical studies; • Advances in the development of prosthetic, orthotic and augmentation devices; • Imaging and diagnostic techniques; • Pathology; • Trauma; • Surgery; • Rehabilitation.