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

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

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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.
Literature
1.
Akizuki S, Yasukawa Y, Takizawa T (1997) 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. Arthroscopy 13:9–17 PubMedCrossRef
2.
Andriolo L, Reale D, Di Martino A, Zaffagnini S, Vannini F, Ferruzzi A et al (2019) High rate of failure after matrix-assisted autologous chondrocyte transplantation in osteoarthritic knees at 15 years of follow-up. Am J Sports Med 47:2116–2122 PubMedCrossRef
3.
Angele P, Niemeyer P, Steinwachs M, Filardo G, Gomoll AH, Kon E et al (2016) Chondral and osteochondral operative treatment in early osteoarthritis. Knee Surg Sports Traumatol Arthrosc 24:1743–1752 PubMedCrossRef
4.
Bauer S, Khan RJ, Ebert JR, Robertson WB, Breidahl W, Ackland TR et al (2012) Knee joint preservation with combined neutralising high tibial osteotomy (HTO) and matrix-induced autologous chondrocyte implantation (MACI) in younger patients with medial knee osteoarthritis: a case series with prospective clinical and MRI follow-up over 5 years. Knee 19:431–439 PubMedCrossRef
5.
Bode G, Schmal H, Pestka JM, Ogon P, Südkamp NP, Niemeyer P (2013) A non-randomized controlled clinical trial on autologous chondrocyte implantation (ACI) in cartilage defects of the medial femoral condyle with or without high tibial osteotomy in patients with varus deformity of less than 5°. Arch Orthop Trauma Surg 133:43–49 PubMedCrossRef
6.
Boffa A, Andriolo L, Franceschini M, Martino AD, Asunis E, Grassi A et al (2021) Minimal clinically important difference and patient acceptable symptom state in patients with knee osteoarthritis treated with PRP injection. Orthop J Sports Med 9:23259671211026240 PubMedPubMedCentralCrossRef
7.
Boffa A, Salerno M, Merli G, De Girolamo L, Laver L, Magalon J et al (2021) Platelet-rich plasma injections induce disease-modifying effects in the treatment of osteoarthritis in animal models. Knee Surg Sports Traumatol Arthrosc 29:4100–4121 PubMedCrossRef
8.
Calcei JG, Varshneya K, Sochacki KR, Safran MR, Abrams GD, Sherman SL (2021) Concomitant osteotomy reduces risk of reoperation following cartilage restoration procedures of the knee: a matched cohort analysis. Cartilage 13:1250s–1257s PubMedPubMedCentralCrossRef
9.
Cavallo M, Sayyed-Hosseinian SH, Parma A, Buda R, Mosca M, Giannini S (2018) Combination of High Tibial Osteotomy and Autologous Bone Marrow Derived Cell Implantation in Early Osteoarthritis of Knee: A Preliminary Study. Arch Bone Jt Surg 6(2):112–118
10.
Chareancholvanich K, Pornrattanamaneewong C, Narkbunnam R (2014) Increased cartilage volume after injection of hyaluronic acid in osteoarthritis knee patients who underwent high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 22:1415–1423 PubMedCrossRef
11.
Chung YW, Yang HY, Kang SJ, Song EK, Seon JK (2021) Allogeneic umbilical cord blood-derived mesenchymal stem cells combined with high tibial osteotomy: a retrospective study on safety and early results. Int Orthop 45:481–488 PubMedCrossRef
12.
13.
14.
15.
Ferruzzi A, Buda R, Cavallo M, Timoncini A, Natali S, Giannini S (2014) Cartilage repair procedures associated with high tibial osteotomy in varus knees: clinical results at 11 years’ follow-up. Knee 21:445–450 PubMedCrossRef
16.
Filardo G, Kon E, Andriolo L, Vannini F, Buda R, Ferruzzi A et al (2013) Does patient sex influence cartilage surgery outcome? Analysis of results at 5-year follow-up in a large cohort of patients treated with matrix-assisted autologous chondrocyte transplantation. Am J Sports Med 41:1827–1834 PubMedCrossRef
17.
Filardo G, Kon E, Di Martino A, Patella S, Altadonna G, Balboni F et al (2012) Second-generation arthroscopic autologous chondrocyte implantation for the treatment of degenerative cartilage lesions. Knee Surg Sports Traumatol Arthrosc 20:1704–1713 PubMedCrossRef
18.
Filardo G, Kon E, Longo UG, Madry H, Marchettini P, Marmotti A et al (2016) Non-surgical treatments for the management of early osteoarthritis. Knee Surg Sports Traumatol Arthrosc 24:1775–1785 PubMedCrossRef
19.
20.
Filardo G, Zaffagnini S, De Filippis R, Perdisa F, Andriolo L, Candrian C (2018) No evidence for combining cartilage treatment and knee osteotomy in osteoarthritic joints: a systematic literature review. Knee Surg Sports Traumatol Arthrosc 26:3290–3299 PubMedCrossRef
21.
22.
Gomoll AH (2011) High tibial osteotomy for the treatment of unicompartmental knee osteoarthritis: a review of the literature, indications, and technique. Phys Sportsmed 39:45–54 PubMedCrossRef
23.
Gomoll AH, Filardo G, Almqvist FK, Bugbee WD, Jelic M, Monllau JC et al (2012) Surgical treatment for early osteoarthritis. Part II: allografts and concurrent procedures. Knee Surg Sports Traumatol Arthrosc 20:468–486 PubMedCrossRef
24.
Hamahashi K, Toyoda E, Ishihara M, Mitani G, Takagaki T, Kaneshiro N, Maehara M, Takahashi T, Okada E, Watanabe A, Nakamura Y, Kato R, Matoba R, Takagi T, Akutsu H, Umezawa A, Kobayashi H, Akamatsu T, Yamato M, Okano T, Watanabe M, Sato M (2022) Polydactyly-derived allogeneic chondrocyte cell-sheet transplantation with high tibial osteotomy as regenerative therapy for knee osteoarthritis. NPJ Regen Med 7(1):71. https://​doi.​org/​10.​1038/​s41536-022-00272-1
25.
Heijink A, Gomoll AH, Madry H, Drobnič M, Filardo G, Espregueira-Mendes J et al (2012) Biomechanical considerations in the pathogenesis of osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 20:423–435 PubMedCrossRef
26.
Hofmann S, Lobenhoffer P, Staubli A, Van Heerwaarden R (2009) Osteotomies of the knee joint in patients with monocompartmental arthritis. Orthopade 38:755–769 ( quiz 770) PubMedCrossRef
27.
Huizinga MR, Gorter J, Demmer A, Bierma-Zeinstra SMA, Brouwer RW (2017) Progression of medial compartmental osteoarthritis 2–8 years after lateral closing-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 25:3679–3686 PubMedCrossRef
28.
29.
30.
Jung WH, Takeuchi R, Chun CW, Lee JS, Jeong JH (2015) Comparison of results of medial opening-wedge high tibial osteotomy with and without subchondral drilling. Arthroscopy 31:673–679 PubMedCrossRef
31.
Kahlenberg CA, Nwachukwu BU, Hamid KS, Steinhaus ME, Williams RJ 3rd (2017) Analysis of outcomes for high tibial osteotomies performed with cartilage restoration techniques. Arthroscopy 33:486–492 PubMedCrossRef
32.
Kanamiya T, Naito M, Hara M, Yoshimura I (2002) The influences of biomechanical factors on cartilage regeneration after high tibial osteotomy for knees with medial compartment osteoarthritis: clinical and arthroscopic observations. Arthroscopy 18:725–729 PubMedCrossRef
33.
34.
Kim JH, Kim KI, Yoon WK, Song SJ, Jin W (2022) Intra-articular injection of mesenchymal stem cells after high tibial osteotomy in osteoarthritic knee: two-year follow-up of randomized control trial. Stem Cells Transl Med 11:572–585 PubMedPubMedCentralCrossRef
35.
36.
Kim MS, Koh IJ, Choi YJ, Pak KH, In Y (2017) Collagen augmentation improves the quality of cartilage repair after microfracture in patients undergoing high tibial osteotomy: a randomized controlled trial. Am J Sports Med 45:1845–1855 PubMedCrossRef
37.
Kim YS, Chung PK, Suh DS, Heo DB, Tak DH, Koh YG (2020) Implantation of mesenchymal stem cells in combination with allogenic cartilage improves cartilage regeneration and clinical outcomes in patients with concomitant high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 28:544–554 PubMedCrossRef
38.
Kim YS, Koh YG (2018) Comparative matched-pair analysis of open-wedge high tibial osteotomy with versus without an injection of adipose-derived mesenchymal stem cells for varus knee osteoarthritis: clinical and second-look arthroscopic results. Am J Sports Med 46:2669–2677 PubMedCrossRef
39.
Koh YG, Kwon OR, Kim YS, Choi YJ (2014) Comparative outcomes of open-wedge high tibial osteotomy with platelet-rich plasma alone or in combination with mesenchymal stem cell treatment: a prospective study. Arthroscopy 30:1453–1460 PubMedCrossRef
40.
41.
Kon E, Verdonk P, Condello V, Delcogliano M, Dhollander A, Filardo G et al (2009) Matrix-assisted autologous chondrocyte transplantation for the repair of cartilage defects of the knee: systematic clinical data review and study quality analysis. Am J Sports Med 37(Suppl 1):156s–166s PubMedCrossRef
42.
Koshino T, Wada S, Ara Y, Saito T (2003) Regeneration of degenerated articular cartilage after high tibial valgus osteotomy for medial compartmental osteoarthritis of the knee. Knee 10:229–236 PubMedCrossRef
43.
Lee NH, Na SM, Ahn HW, Kang JK, Seon JK, Song EK (2021) Allogenic human umbilical cord blood-derived mesenchymal stem cells are more effective than bone marrow aspiration concentrate for cartilage regeneration after high tibial osteotomy in medial unicompartmental osteoarthritis of knee. Arthroscopy 37:2521–2530 PubMedCrossRef
44.
45.
46.
Madry H, Kon E, Condello V, Peretti GM, Steinwachs M, Seil R et al (2016) Early osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 24:1753–1762 PubMedCrossRef
47.
48.
Marcacci M, Filardo G, Kon E (2013) Treatment of cartilage lesions: what works and why? Injury 44(Suppl 1):S11-15 PubMedCrossRef
49.
Matsunaga D, Akizuki S, Takizawa T, Yamazaki I, Kuraishi J (2007) Repair of articular cartilage and clinical outcome after osteotomy with microfracture or abrasion arthroplasty for medial gonarthrosis. Knee 14:465–471 PubMedCrossRef
50.
Miller BS, Joseph TA, Barry EM, Rich VJ, Sterett WI (2007) Patient satisfaction after medial opening high tibial osteotomy and microfracture. J Knee Surg 20:129–133 PubMedCrossRef
51.
52.
Parker DA, Beatty KT, Giuffre B, Scholes CJ, Coolican MR (2011) Articular cartilage changes in patients with osteoarthritis after osteotomy. Am J Sports Med 39:1039–1045 PubMedCrossRef
53.
Pascale W, Luraghi S, Perico L, Pascale V (2011) Do microfractures improve high tibial osteotomy outcome? Orthopedics 34:e251–e255 PubMedCrossRef
54.
55.
Perucca Orfei C, Boffa A, Sourugeon Y, Laver L, Magalon J, Sánchez M et al (2023) Cell-based therapies have disease-modifying effects on osteoarthritis in animal models. A systematic review by the ESSKA Orthobiologic Initiative. Part 1: adipose tissue-derived cell-based injectable therapies. Knee Surg Sports Traumatol Arthrosc 31:641–655 PubMedCrossRef
56.
Primeau CA, Birmingham TB, Leitch KM, Willits KR, Litchfield RB, Fowler PJ et al (2021) Total knee replacement after high tibial osteotomy: time-to-event analysis and predictors. CMAJ 193:E158-e166 PubMedPubMedCentralCrossRef
57.
Pulsatelli L, Addimanda O, Brusi V, Pavloska B, Meliconi R (2013) New findings in osteoarthritis pathogenesis: therapeutic implications. Ther Adv Chronic Dis 4:23–43 PubMedPubMedCentralCrossRef
58.
59.
Schultz W, Göbel D (1999) 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 7:29–36 PubMedCrossRef
60.
Schuster P, Geßlein M, Schlumberger M, Mayer P, Mayr R, Oremek D et al (2018) Ten-Year results of medial open-wedge high tibial osteotomy and chondral resurfacing in severe medial osteoarthritis and varus malalignment. Am J Sports Med 46:1362–1370 PubMedCrossRef
61.
Schuster P, Schulz M, Mayer P, Schlumberger M, Immendoerfer M, Richter J (2015) 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. Arthroscopy 31:1279–1288 PubMedCrossRef
62.
Schuster P, Schulz M, Richter J (2016) Combined biplanar high tibial osteotomy, anterior cruciate ligament reconstruction, and abrasion/microfracture in severe medial osteoarthritis of unstable varus knees. Arthroscopy 32:283–292 PubMedCrossRef
63.
Solanki K, Shanmugasundaram S, Shetty N, Kim SJ (2021) Articular cartilage repair & joint preservation: a review of the current status of biological approach. J Clin Orthop Trauma 22:101602 PubMedPubMedCentralCrossRef
64.
Song JS, Hong KT, Kong CG, Kim NM, Jung JY, Park HS et al (2020) High tibial osteotomy with human umbilical cord blood-derived mesenchymal stem cells implantation for knee cartilage regeneration. World J Stem Cells 12:514–526 PubMedPubMedCentralCrossRef
65.
Souza LAB, Rocha VMD, Ramos MRF (2018) The role of microfractures with tibial osteotomy in the treatment of knee osteoarthritis with a varus deformity. Rev Bras Ortop 53:754–760 PubMedPubMedCentralCrossRef
66.
Sterett WI, Steadman JR (2004) Chondral resurfacing and high tibial osteotomy in the varus knee. Am J Sports Med 32:1243–1249 PubMedCrossRef
67.
Sterett WI, Steadman JR, Huang MJ, Matheny LM, Briggs KK (2010) Chondral resurfacing and high tibial osteotomy in the varus knee: survivorship analysis. Am J Sports Med 38:1420–1424 PubMedCrossRef
68.
Suh DW, Han SB, Yeo WJ, Cheong K, So SY, Kyung BS (2021) Human umbilical cord-blood-derived mesenchymal stem cell can improve the clinical outcome and Joint space width after high tibial osteotomy. Knee 33:31–37 PubMedCrossRef
69.
Vannini F, Spalding T, Andriolo L, Berruto M, Denti M, Espregueira-Mendes J et al (2016) Sport and early osteoarthritis: the role of sport in aetiology, progression and treatment of knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 24:1786–1796 PubMedCrossRef
70.
Wakitani S, Imoto K, Yamamoto T, Saito M, Murata N, Yoneda M (2002) Human autologous culture expanded bone marrow mesenchymal cell transplantation for repair of cartilage defects in osteoarthritic knees. Osteoarthritis Cartilage 10:199–206 PubMedCrossRef
71.
Wong KL, Lee KB, Tai BC, Law P, Lee EH, Hui JH (2013) 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 29:2020–2028 PubMedCrossRef
72.
73.
Yang J, Liu L, Xu X, Han Y, Yu W (2021) Percutaneous fixation with helical bridge combined fixation system for long split fractures involving the middle and upper humerus. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 35:1422–1426 PubMed
74.
Zaffagnini S, Dal Fabbro G, Belvedere C, Leardini A, Caravelli S, Lucidi GA et al (2022) Custom-made devices represent a promising tool to increase correction accuracy of high tibial osteotomy: a systematic review of the literature and presentation of pilot cases with a new 3D-printed system. J Clin Med 11(19):5717 PubMedPubMedCentralCrossRef
75.
76.
Zhang Q, Xu W, Wu K, Fu W, Yang H, Guo JJ (2022) Intra-articular pure platelet-rich plasma combined with open-wedge high tibial osteotomy improves clinical outcomes and minimal joint space width compared with high tibial osteotomy alone in knee osteoarthritis: a prospective study. Arthroscopy 38:476–485 PubMedCrossRef
77.
Zitsch BP, Stannard JP, Worley JR, Cook JL, Leary EV (2021) Patient-reported outcomes for large bipolar osteochondral allograft transplantation in combination with realignment osteotomies for the knee. J Knee Surg 34:1260–1266 PubMedCrossRef
Metadata
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
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

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