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Title: [Short-term effectiveness of high tibial osteotomy combined with arthroscopic surgery for knee varus arthritis and the results of secondary arthroscopic exploration].
Author: Zhong H, Jin Y, Liu X, Yang J, Wu S, Liu Y.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2022 Aug 15; 36(8):969-975. PubMed ID: 35979788.
Abstract:
OBJECTIVE: To investigate the effectiveness of high tibial osteotomy (HTO) combined with arthroscopic surgery to treat medial compartment knee osteoarthritis (KOA) and secondary arthroscopic exploration to evaluate the outcome of cartilage and meniscus. METHODS: A clinical data of 57 patients with medial compartment KOA with varus deformity of lower extremities admitted between August 2014 and October 2018 were retrospectively analyzed. There were 23 males and 34 females with an average age of 51.2 years (range, 41-63 years). The disease duration ranged from 2 to 8 years, with an average of 4.7 years. The preoperative femorotibial angle was (179.86±4.69)°, the relative position of the lower limb mechanical axis passing through the tibial plateau was 24.21%±6.98%, and the posterior slope of the tibial plateau was (5.23±1.45)°. The Kellgren-Lawrence grade of knee joint was grade Ⅱ in 22 cases and grade Ⅲ in 35 cases. The preoperative Hospital for Special Surgery (HSS) score, Lysholm score, and visual analogue scale (VAS) score were 59.1±7.3, 48.8±7.6, and 6.2±1.1, respectively. Arthroscopic exploration was performed during the operation to record the articular cartilage degeneration in the weight-bearing area of the medial compartment (Outerbridge grade Ⅰ in 18 cases, grade Ⅱ in 30 cases, and grade Ⅲ in 9 cases) and the condition of the medial meniscus injury, and the corresponding treatment was performed. The coronal force line was adjusted according to the preoperative Kellgren-Lawrence grade of the knee joint during the operation. After operation, the relative position of the lower limb mechanical axis passing through the tibial plateau, the femorotibial angle, and the posterior slope of the tibial plateau were measured; the Kellgren-Lawrence grade of the knee joint was recorded; the Outerbridge grade of articular cartilage degeneration and the meniscus outcome were evaluated by combining with the MRI of the knee joint at 1 year after operation and the second arthroscopic exploration when the internal fixator was removed. The function and pain of the knee were evaluated by Lysholm score, HSS score, and VAS score. RESULTS: All the 57 patients were followed up 36-58 months with an average of 42.1 months. Incisions healed by first intention, and no neurovascular injury, intraarticular or hinge fractures occurred during operation, and no postoperative complications such as deep vein thrombosis of lower limbs and internal fixation failure occurred. All the osteotomy sites healed at 3 months after operation. At 1 year after operation, the internal fixator was removed, and the second arthroscopic exploration showed that there were 15 cases of Outerbridge grade Ⅰ, 31 cases of grade Ⅱ, and 11 cases of grade Ⅲ in the weight-bearing area of the medial compartment, and there was no significant difference when compared with preoperative grade ( Z=31.992, P=0.997); there was no cartilage degeneration in other compartments. Meniscus healing was seen in the injured meniscus, and no injury was seen in the normal meniscus. At last follow-up, there were 19 cases of Kellgren-Lawrence grade Ⅱ and 38 cases of grade Ⅲ, and there was no significant difference when compared with preoperative grade ( Z=49.049, P=0.764). The relative position of the lower limb mechanical axis passing through the tibial plateau was 59.16%±2.87%, and the femorotibial angle was (171.54±3.39)°, which significantly improved when compared with those before operation ( P<0.001). The posterior slope of the tibial plateau was (5.65±1.22)°, which was not significantly different from that before operation ( t=-1.673, P=0.096). The HSS score, Lysholm score, and VAS score were 82.3±7.7, 83.4±6.4, and 1.6±1.1 respectively, which were significantly different from those before operation ( P<0.001). CONCLUSION: HTO combined with arthroscopic surgery for medial compartment KOA with varus deformity of lower extremities can effectively improve the force line of lower extremities, relieve pain symptoms, and improve joint function, with satisfactory short-term effectiveness, and without significant progress in articular cartilage or meniscus injury after operation. 目的: 探讨胫骨高位截骨术（high tibial osteotomy，HTO）联合关节镜手术治疗内侧间室膝关节骨关节炎（knee osteoarthritis，KOA）的近期疗效，并二次关节镜探查评估软骨及半月板转归。. 方法: 回顾分析2014年8月—2018年10月收治的57例合并膝内翻畸形的内侧间室KOA患者临床资料。男23例，女34例；年龄41～63岁，平均51.2岁。病程2～8年，平均4.7年。术前股胫角为（179.86±4.69）°，下肢机械轴通过胫骨平台的相对位置为24.21%±6.98%，胫骨平台后倾角为（5.23±1.45）°。膝关节Kellgren-Lawrence分级为Ⅱ级22例、Ⅲ级35例。术前美国特种外科医院（HSS）膝关节评分为（59.1±7.3）分，Lysholm评分为（48.8±7.6）分，疼痛视觉模拟评分（VAS）为（6.2±1.1）分。术中关节镜探查记录内侧胫骨平台负重区软骨退变（Outerbridge分级为Ⅰ级18例、Ⅱ级30例、Ⅲ级9例）及内侧半月板损伤情况并行相应治疗；HTO术中根据术前膝关节Kellgren-Lawrence分级调整冠状面力线。术后测量下肢机械轴通过胫骨平台的相对位置、股胫角和胫骨平台后倾角；记录术后膝关节Kellgren-Lawrence分级；结合术后1年膝关节MRI以及内固定物取出时二次关节镜探查，评估关节软骨退变Outerbridge分级及半月板转归；膝关节功能和疼痛程度采用Lysholm评分、HSS评分和VAS评分进行评价。. 结果: 57例患者均获随访，随访时间36～58个月，平均42.1个月。切口均Ⅰ期愈合，术中无神经血管损伤、关节内及合页骨折，术后无下肢深静脉血栓形成、内固定失效等并发症发生；术后3个月截骨部位均获骨性愈合。术后1年取出内固定物，二次关节镜探查示内侧间室负重区软骨退变Outerbridge分级为Ⅰ级15例、Ⅱ级31例、Ⅲ级11例，与术中比较差异无统计学意义（ Z=31.992， P=0.997）；其他间室未见软骨退变。损伤半月板可见半月板愈合表现，正常半月板未见损伤进展。末次随访时，Kellgren-Lawrence分级为Ⅱ级19例、Ⅲ级38例，与术前比较差异无统计学意义（ Z=49.049， P=0.764）。下肢机械轴通过胫骨平台的相对位置为59.16%±2.87%，股胫角为（171.54±3.39）°，均较术前显著改善（ P<0.001）；胫骨平台后倾角为（5.65±1.22）°，与术前比较差异无统计学意义（ t=−1.673， P=0.096）。HSS评分、Lysholm评分和VAS评分分别为（82.3±7.7）、（83.4±6.4）、（1.6±1.1）分，均较术前显著改善（ P<0.001）。. 结论: HTO联合关节镜手术治疗合并膝内翻畸形的内侧间室KOA，可有效改善下肢力线、缓解疼痛症状、改善关节功能，近期疗效满意，术后关节软骨退变及半月板损伤未见明显进展。.

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