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Tibiofemoral Cartilage Defect with Malalignment

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Joint Preservation of the Knee

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Abstract

Tibiofemoral cartilage defects are often found in concurrence with and may be secondary to malalignment. This case discusses the treatment and evaluation of a 34-year-old female with a history of 2 years of atraumatic medial knee pain with prior partial meniscectomy found to have varus malalignment of 6° and a 2 cm2 chondral defect in the medial femoral condyle with an intact subchondral bone plate. When determining the appropriate treatment for a patient with these or similar symptoms, factors to consider include the following: degree of malalignment, smoking status, BMI, contralateral defects, concomitant meniscal lesions, extent of arthritis, range of motion, and likelihood of postoperative compliance. This discussion uses a review of recent literature to address the process of choosing an appropriate treatment and determining whether or not to correct cartilage abnormalities in conjunction with misalignment correction.

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References

  1. Amis AA. Biomechanics of high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2013;21(1):197–205. https://doi.org/10.1007/s00167-012-2122-3.

    Article  PubMed  Google Scholar 

  2. Tsukada S, Wakui M. Is overcorrection preferable for repair of degenerated articular cartilage after open-wedge high tibial osteotomy? Knee Surg Sports Traumatol Arthrosc. 2017;25(3):785–92. https://doi.org/10.1007/s00167-015-3655-z.

    Article  PubMed  Google Scholar 

  3. Smith JO, Wilson AJ, Thomas NP. Osteotomy around the knee: Evolution, principles and results. Knee Surg Sports Traumatol Arthrosc. 2013;21(1):3–22. https://doi.org/10.1007/s00167-012-2206-0.

    Article  CAS  PubMed  Google Scholar 

  4. Bonasia DE, Dettoni F, Sito G, et al. Medial opening wedge high tibial osteotomy for medial compartment overload/arthritis in the varus knee. Am J Sports Med. 2014;42(3):690–8. https://doi.org/10.1177/0363546513516577.

    Article  PubMed  Google Scholar 

  5. Minzlaff P, Saier T, Brucker PU, Haller B, Imhoff AB, Hinterwimmer S. Valgus bracing in symptomatic varus malalignment for testing the expectable “unloading effect” following valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2015;23(7):1964–70. https://doi.org/10.1007/s00167-013-2832-1.

    Article  PubMed  Google Scholar 

  6. Gomoll AH, Filardo G, Almqvist FK, et al. Surgical treatment for early osteoarthritis. Part II: Allografts and concurrent procedures. Knee Surg Sports Traumatol Arthrosc. 2012;20(3):468–86. https://doi.org/10.1007/s00167-011-1714-7.

    Article  CAS  PubMed  Google Scholar 

  7. Gomoll AH, Angele P, Condello V, et al. Load distribution in early osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2016;24(6):1815–25. https://doi.org/10.1007/s00167-016-4123-0.

    Article  PubMed  Google Scholar 

  8. Kanneganti P, Harris JD, Brophy RH, Carey JL, Lattermann C, Flanigan DC. The effect of smoking on ligament and cartilage surgery in the knee. Am J Sports Med. 2012;40(12):2872–8. https://doi.org/10.1177/0363546512458223.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kumagai K, Akamatsu Y, Kobayashi H, Kusayama Y, Koshino T, Saito T. Factors affecting cartilage repair after medial opening-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2017;25(3):779–84. https://doi.org/10.1007/s00167-016-4096-z.

    Article  PubMed  Google Scholar 

  10. Gardiner A, Gutiérrez Sevilla GR, Steiner ME, Richmond JC. Osteotomies about the knee for tibiofemoral malalignment in the athletic patient. Am J Sports Med. 2010;38(5):1038–47. https://doi.org/10.1177/0363546509335193.

    Article  PubMed  Google Scholar 

  11. Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P. Outcome after high tibial open-wedge osteotomy: A retrospective evaluation of 533 patients. Knee Surg Sports Traumatol Arthrosc. 2013;21(1):170–80. https://doi.org/10.1007/s00167-012-2087-2.

    Article  PubMed  Google Scholar 

  12. Jung W-H, Takeuchi R, Chun C-W, et al. Second-look arthroscopic assessment of cartilage regeneration after medial opening-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2014;30(1):72–9. https://doi.org/10.1016/j.arthro.2013.10.008.

    Article  Google Scholar 

  13. Niemeyer P, Koestler W, Kaehny C, et al. Two-year results of open-wedge high tibial osteotomy with fixation by medial plate fixator for medial compartment arthritis with varus malalignment of the knee. Arthroscopy. 2008;24(7):796–804. https://doi.org/10.1016/j.arthro.2008.02.016.

    Article  PubMed  Google Scholar 

  14. Niemeyer P, Schmal H, Hauschild O, Von Heyden J, Sdkamp NP, Kstler W. Open-wedge osteotomy using an internal plate fixator in patients with medial-compartment gonarthritis and varus malalignment: 3-year results with regard to preoperative arthroscopic and radiographic findings. Arthroscopy. 2010;26(12):1607–16. https://doi.org/10.1016/j.arthro.2010.05.006.

    Article  PubMed  Google Scholar 

  15. Bode G, von Heyden J, Pestka J, et al. Prospective 5-year survival rate data following open-wedge valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2015;23(7):1949–55. https://doi.org/10.1007/s00167-013-2762-y.

    Article  PubMed  Google Scholar 

  16. Hantes ME, Natsaridis P, Koutalos AA, Ono Y, Doxariotis N, Malizos KN. Satisfactory functional and radiological outcomes can be expected in young patients under 45 years old after open wedge high tibial osteotomy in a long-term follow-up. Knee Surg Sports Traumatol Arthrosc. 2017. https://doi.org/10.1007/s00167-017-4816-z.

    Article  PubMed  Google Scholar 

  17. Salzmann GM, Ahrens P, Naal FD, et al. Sporting activity after high tibial osteotomy for the treatment of medial compartment knee osteoarthritis. Am J Sports Med. 2009;37(2):312–8. https://doi.org/10.1177/0363546508325666.

    Article  PubMed  Google Scholar 

  18. Kanamiya T, Naito M, Hara M, Yoshimura I. The influences of biomechanical factors on cartilage regeneration after high tibial osteotomy for knees with medial compartment osteoarthritis: Clinical and arthroscopic observations. Arthroscopy. 2002;18(7):725–9. https://doi.org/10.1053/jars.2002.35258.

    Article  PubMed  Google Scholar 

  19. van Egmond N, van Grinsven S, van Loon CJM, Gaasbeek RD, van Kampen A. Better clinical results after closed- compared to open-wedge high tibial osteotomy in patients with medial knee osteoarthritis and varus leg alignment. Knee Surg Sports Traumatol Arthrosc. 2016;24(1):34–41. https://doi.org/10.1007/s00167-014-3303-z.

    Article  PubMed  Google Scholar 

  20. Schultz W, Göbel D. Articular cartilage regeneration of the knee joint after proximal tibial valgus osteotomy: a prospective study of different intra- and extra-articular operative techniques. Knee Surg Sports Traumatol Arthrosc. 1999;7(1):29–36. https://doi.org/10.1007/s001670050117.

    Article  CAS  PubMed  Google Scholar 

  21. Montgomery SR, Foster BD, Ngo SS, et al. Trends in the surgical treatment of articular cartilage defects of the knee in the United States. Knee Surg Sports Traumatol Arthroscz. 2014;22(9):2070–5. https://doi.org/10.1007/s00167-013-2614-9.

    Article  Google Scholar 

  22. Parker DA, Beatty KT, Giuffre B, Scholes CJ, Coolican MRJ. Articular cartilage changes in patients with osteoarthritis after osteotomy. Am J Sports Med. 2011;39(5):1039–45. https://doi.org/10.1177/0363546510392702.

    Article  PubMed  Google Scholar 

  23. Sterett WI, Steadman JR. Chondral resurfacing and high tibial osteotomy in the varus knee. Am J Sports Med. 2004;32(5):1243–9. https://doi.org/10.1177/0363546503259301.

    Article  PubMed  Google Scholar 

  24. Schuster P, Schulz M, Mayer P, Schlumberger M, Immendoerfer M, Richter J. Open-wedge high tibial osteotomy and combined abrasion/microfracture in severe medial osteoarthritis and varus malalignment: 5-year results and arthroscopic findings after 2 years. Arthrosc J Arthrosc Relat Surg. 2015;31(7):1279–88. https://doi.org/10.1016/j.arthro.2015.02.010.

    Article  Google Scholar 

  25. Jung W-H, Takeuchi R, Chun C-W, Lee J-S, Jeong J-H. Comparison of results of medial opening-wedge high tibial osteotomy with and without subchondral drilling. Arthrosc J Arthrosc Relat Surg. 2015;31(4):673–9. https://doi.org/10.1016/j.arthro.2014.11.035.

    Article  Google Scholar 

  26. Akizuki S, Yasukawa Y, Takizawa T. Does arthroscopic abrasion arthroplasty promote cartilage regeneration in osteoarthritic knees with eburnation? A prospective study of high tibial osteotomy with abrasion arthroplasty versus high tibial osteotomy alone. Arthrosc J Arthrosc Relat Surg. 1997;13(1):9–17. https://doi.org/10.1016/S0749-8063(97)90204-8.

    Article  CAS  Google Scholar 

  27. Sterett WI, Steadman JR, Huang MJ, Matheny LM, Briggs KK. Chondral resurfacing and high tibial osteotomy in the varus knee. Am J Sports Med. 2010;38(7):1420–4. https://doi.org/10.1177/0363546509360403.

    Article  PubMed  Google Scholar 

  28. Harris JD, Hussey K, Wilson H, et al. Biological knee reconstruction for combined malalignment, meniscal deficiency, and articular cartilage disease. Arthrosc J Arthrosc Relat Surg. 2015;31(2):275–82. https://doi.org/10.1016/j.arthro.2014.08.012.

    Article  Google Scholar 

  29. Kim MS, Koh IJ, Choi YJ, Pak KH, In Y. Collagen augmentation improves the quality of cartilage repair after microfracture in patients undergoing high tibial osteotomy: a randomized controlled trial. Am J Sports Med. 2017;45(8):1845–55. https://doi.org/10.1177/0363546517691942.

    Article  PubMed  Google Scholar 

  30. Saw K-Y, Anz A, Jee CS-Y, Ng RC-S, Mohtarrudin N, Ragavanaidu K. High tibial osteotomy in combination with chondrogenesis after stem cell therapy: a histologic report of 8 cases. Arthrosc J Arthrosc Relat Surg. 2015;31(10):1909–20. https://doi.org/10.1016/j.arthro.2015.03.038.

    Article  Google Scholar 

  31. Wong KL, Lee KBL, Tai BC, Law P, Lee EH, Hui JHP. Injectable cultured bone marrow-derived mesenchymal stem cells in varus knees with cartilage defects undergoing high tibial osteotomy: A prospective, randomized controlled clinical trial with 2 years’ follow-up. Arthroscopy. 2013;29(12):2020–8. https://doi.org/10.1016/j.arthro.2013.09.074.

    Article  PubMed  Google Scholar 

  32. Agneskirchner JD, Hurschler C, Wrann CD, Lobenhoffer P. The effects of valgus medial opening wedge high tibial osteotomy on articular cartilage pressure of the knee: a biomechanical study. Arthroscopy. 2007;23(8):852–61. https://doi.org/10.1016/j.arthro.2007.05.018.

    Article  PubMed  Google Scholar 

  33. Nakayama H, Schröter S, Yamamoto C, et al. Large correction in opening wedge high tibial osteotomy with resultant joint-line obliquity induces excessive shear stress on the articular cartilage. Knee Surg Sports Traumatol Arthroscz. 2017:1–6. https://doi.org/10.1007/s00167-017-4680-x.

    Article  PubMed  Google Scholar 

  34. Lash NJ, Feller JA, Batty LM, Wasiak J, Richmond AK. Bone grafts and bone substitutes for opening-wedge osteotomies of the knee: a systematic review. Arthroscopy. 2015;31(4):720–30. https://doi.org/10.1016/j.arthro.2014.09.011.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Christian Lattermann

  2. Steadman Philippon Clinic, Vail, CO, USA

    Burak Altintas

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  1. Christian Lattermann
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  2. Burak Altintas
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Correspondence to Christian Lattermann .

Editor information

Editors and Affiliations

  1. Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA

    Adam B. Yanke

  2. Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA

    Brian J. Cole

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Lattermann, C., Altintas, B. (2019). Tibiofemoral Cartilage Defect with Malalignment. In: Yanke, A., Cole, B. (eds) Joint Preservation of the Knee. Springer, Cham. https://doi.org/10.1007/978-3-030-01491-9_15

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  • DOI: https://doi.org/10.1007/978-3-030-01491-9_15

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-01490-2

  • Online ISBN: 978-3-030-01491-9

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