Alignment Osteotomies

Abstract

Because articular cartilage has a limited capacity for healing, patients have often been treated symptomatically until they became candidates for osteotomy or total knee arthroplasty. Recently, both reparative and restorative procedures have been developed to address this significant source of morbidity in young active patients. Medial opening wedge high tibial osteotomy (HTO) provides subjective improvements in pain and quality of life, but the potential benefit of allowing articular cartilage preservation and possible regeneration is not well established. It has been shown that after a non-weight bearing period, the rate of change in the medial compartment changes from negative to positive, indicating the potential for articular cartilage recovery secondary to an improved mechanical environment. Microfracture associated to HTO seems to contribute to a delay of TKA in active patients with varus gonarthrosis. Matrix-induced autologous chondrocyte implantation (MACI) associated to osteotomy provides a safe treatment option for younger patients with medial knee osteoarthritis and varus alignment with significant clinical improvement at 5 years. However, overall graft survival and cartilage infill are poor. Larger studies are needed to statistically verify predictors for longer term cartilage repair in these patients.