gms | German Medical Science

Objectives: Osteochondral defects of the medial femoral condyle combined with varus malalignment in young and active patients are a debilitating condition, which can result in early osteoarthritis. Osteochondral autologous transfer (OAT) combined with valgus high tibial osteotomy (HTO) might therefore be The purpose was to report clinical results and survivorship following combined OAT and valgus HTO for symptomatic osteochondral defects of the medial femoral condyle in the setting of varus malalignment at a long term follow-up. It was hypothesized that undergoing combined OAT and valgus HTO would produce favorable clinical results along with a low rate of conversion to arthroplasty.

Methods: Between 1998 and 2008, all patients treated with combined valgus HTO and OAT for deep osteochondral defects of the medial femoral condyle and concomitant varus malalignment > 2° without meniscal-repair/-transplantation, osteoarthritis or ligamentous instability/reconstruction were included. The survival-rates of this combined procedure were evaluated. Failure was defined as conversion to knee joint arthroplasty during the follow-up period. Patient reported outcomes were collected pre- and postoperatively including the Lysholm score, Visual Analogue Scale (VAS), KOOS, Tegner Activity Score (TAS), and subjective level of satisfaction (scale 0–10).

Results and conclusion: 74 patients were evaluated in first review after 10 years, of which 3 deceased. 56 patients could be evaluated (Follow-up: 80%) The mean age at surgery was 38.8 ± 9.9 years (range, 19.9 – 62.4 years) and the mean follow-up time was 18.9 ± 2.9 years (median, 18.8, range, 14.1 – 24.4 years).The survival-rates were 87% at 10 years, 86% at 15 years, and 77% at 19 ± 3 years (range, 14 – 24 years) after surgery. At final follow-up, the Lysholm score showed a mean increase of 38 points (95% CI: 25.4 – 50.0, p <0.001) from 40 to 79, representing a significant improvement. 96% surpassed the minimal clinically important difference (MCID). The VAS decreased by a mean of 4.8 points (range, 5 – 10, p<0.001) from 7.5 to 2.7. 80% surpassed the MCID. Mean TAS resulted in 4.7 ± 1.6 and the mean KOOS subscale scores at final follow-up were as follows: Pain: 82 ± 21 (range, 19 – 100), Symptoms: 80 ± 21 (range, 21 – 100), ADL: 85 ± 21 (range, 18 – 100), Sport: 68 ± 30 (range, 0 – 100), QoL: 67 ± 26 (range, 0 – 100). 78% of the patients were satisfied with the results of the operation.

The combination of OAT and valgus HTO presents a viable treatment option for patients affected by osteochondral defects of the medial femoral condyle and concurrent varus malalignment. A sustained and substantial improvement in clinical outcomes, significantly reduced pain severity, and a high rate of long-term survivorship can be anticipated in the long-term follow-up.