Cartilage repair examined by second-look arthroscopy following double-level osteotomy performed for osteoarthritic knees with severe varus deformity

Abstract

Background: The purpose of this study was to examine the status of cartilage repair by second-look arthroscopy following double-level osteotomy (DLO) performed for osteoarthritic knees with severe varus deformity.

Methods: Forty-seven consecutive knees in 33 patients who underwent DLO were included in the study. The surgical technique used was a minimally invasive DLO procedure combining lateral closed-wedge distal femoral and medial open-wedge high tibial osteotomies. In the second-look arthroscopic evaluation, the following grading system proposed by Koshino was adopted: Stage A, no repair; stage B, pink fibrous tissue with or without partial coverage with white fibrocartilage; and stage C, total coverage with cartilage. The findings corresponding to stage B or C were considered as repaired. Arthroscopic assessment was performed for each compartment. Clinical outcomes were evaluated using the validated outcome measures.

Results: The mean age at surgery was 62.8 ± 6.2 years (range: 45-75 years), and the mean time period from DLO to second-look arthroscopy was 17.1 ± 5.0 months (range: 12-33 months). Cartilage repair to some extent was identified in over 90% of the medial femoral and tibial condyles, and 12.8% of the patellar facet. As for clinical scores, both Knee Injury and Osteoarthritis Outcome Score (KOOS) and the International Knee Documentation Committee Subjective Knee Form (IKDC) subjective scores significantly improved after surgery (P < 0.01).

Conclusions: Evaluation of the present study subjects showed that DLO could induce cartilage repair in the majority of the affected femoral and tibial articular surfaces with significant clinical improvement. In the patellar facet, however, cartilage repair could be identified in only 12.8% of cases.

Keywords: Cartilage repair; Double-level osteotomy; Knee; Osteoarthritis; Osteotomy; Repair.