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Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

18-06-2023 | Osteoarthrosis | KNEE

Biological intra-articular augmentation for osteotomy in knee osteoarthritis: strategies and results

A systematic review of the literature from the ESSKA Orthobiologics Initiative

Authors: Davide Reale, Pietro Feltri, Marco Franceschini, Laura de Girolamo, Lior Laver, Jeremy Magalon, Mikel Sanchez, Thomas Tischer, Giuseppe Filardo

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 10/2023

Abstract

Purpose

To assess whether there is evidence supporting the use of augmentation strategies, either cartilage surgical procedures or injective orthobiologic options, to improve the results of osteotomies in knees with osteoarthritis (OA).

Methods

A systematic review of the literature was performed on the PubMed, Web of Science and the Cochrane databases in January 2023 on osteotomies around the knee associated with augmentation strategies (either cartilage surgical procedures or injective orthobiologic options), reporting clinical, radiological, or second-look/histological outcomes at any follow-up. The methodological quality of the included studies was assessed with the Coleman Methodology Score (CMS).

Results

Out of the 7650 records identified from the databases, 42 articles were included for a total of 3580 patients and 3609 knees treated; 33 articles focused on surgical treatments and 9 on injective treatments performed in association with knee osteotomy. Out of the 17 comparative studies with surgical augmentation, only 1 showed a significant clinical benefit of an augmentation procedure with a regenerative approach. Overall, other studies showed no differences with reparative techniques and even detrimental outcomes with microfractures. Regarding injective procedures, viscosupplementation showed no improvement, while the use of platelet-rich plasma or cell-based products derived from both bone marrow and adipose tissue showed overall positive tissue changes which translated into a clinical benefit. The mean modified CMS score was 60.0 ± 12.1.

Conclusion

There is no evidence to support the effectiveness of cartilage surgical treatments combined with osteotomies in terms of pain relief and functional recovery of patients affected by OA in misaligned joints. Orthobiologic injective treatments targeting the whole joint environment showed promising findings. However, overall the available literature presents a limited quality with only few heterogeneous studies investigating each treatment option. This ORBIT systematic analysis will help surgeons to choose their therapeutic strategy according to the available evidence, and to plan further and better studies to optimize biologic intra-articular osteotomy augmentation.

Level of evidence

Level IV.

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Title: Biological intra-articular augmentation for osteotomy in knee osteoarthritis: strategies and results
A systematic review of the literature from the ESSKA Orthobiologics Initiative
Authors: Davide Reale
Pietro Feltri
Marco Franceschini
Laura de Girolamo
Lior Laver
Jeremy Magalon
Mikel Sanchez
Thomas Tischer
Giuseppe Filardo
Publication date: 18-06-2023
Publisher: Springer Berlin Heidelberg
Keywords: Osteoarthrosis
Osteoarthrosis
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 10/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-023-07469-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Biological intra-articular augmentation for osteotomy in knee osteoarthritis: strategies and results

A systematic review of the literature from the ESSKA Orthobiologics Initiative

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

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