Repair of articular cartilage and clinical outcome after osteotomy with microfracture or abrasion arthroplasty for medial gonarthrosis.

This study compared the healing of articular cartilage and the clinical outcome after osteotomy with or without marrow stimulation microfracture or abrasion arthroplasty for osteoarthritis of the knee. Patients with osteoarthritis of the medial compartment of the knee were divided into a group undergoing high tibial osteotomy alone (HTO group: 37 knees), a group undergoing osteotomy plus microfracture (MF group: 26 knees), and a group undergoing osteotomy plus abrasion arthroplasty (AA group: 51 knees). The extent of cartilage repair was compared at 1 year after surgery by arthroscopy with reference to Outerbridge's classification, while the clinical outcome was compared at 1, 3, and 5 years postoperatively. Second-look arthroscopy revealed better repair of the femoral condylar cartilage in the AA group than the HTO group (p<0.0005) or MF group (p<0.01), with no difference between the HTO and MF groups. Repair of the tibial condylar cartilage was also better in the AA group than the HTO group (p<0.005), but there was no difference between the AA and MF groups or the MF and HTO groups. There were no differences of the clinical outcome between the three groups. In conclusion, repair of articular cartilage at 1 year postoperatively was accelerated by abrasion arthroplasty, but not by microfracture. However, there was no difference of the clinical outcome within 5 years after surgery, so the clinical utility of marrow stimulation techniques was not apparent in this study.

Arthroscopic lateral meniscectomy in knees with lateral compartment osteoarthritis: a case series study.

PURPOSE: The purpose of this study was to investigate the intermediate-term postoperative results of arthroscopic surgery for lateral compartment osteoarthritis (OA) of the knee in a case series study. METHODS: In a series of 30 knees in 29 patients who underwent arthroscopic surgery for lateral compartment OA, we were able to observe 25 joints in 24 patients prospectively for the entire postoperative period. The follow-up period ranged from 1 to 13 years, with a mean of 5.5 +/- 3.7 years. The procedure in all cases comprised lateral partial meniscectomy with either abrasion arthroplasty, or debridement of the articular cartilage surface or microfracture. Of 25 cases, 13 underwent abrasion arthroplasty, 10 underwent debridement of the articular cartilage surface, and 2 underwent microfracture. Results were assessed by use of the postoperative knee score, findings of arthritic changes on plain knee radiographs, and other measurements of postoperative progress. RESULTS: Further surgery was required in 2 cases (8%) because of poor postoperative progress. In the remaining 22 patients, knee scores improved from a mean of 52.4 points preoperatively to 84.6 points postoperatively and mean function scores improved from 45.4 points to 82.6 points, with these favorable results being maintained at the last follow-up. The femoral-tibial angle decreased slightly as each year passed postoperatively. Radiologic progression of OA was seen at 3 years postoperatively in 7 patients (28%), but no progression was seen in 12 (48%). A positive correlation was seen between the preoperative femoral-tibial angle and postoperative results (R = 0.81, P < .01). CONCLUSIONS: When lateral compartment OA and lateral meniscal tears are both present, the clinical outcome of lateral meniscal resection was favorable. In patients with lateral compartment OA, therefore, an arthroscopic procedure, including meniscectomy, should be considered early. LEVEL OF EVIDENCE: Level IV, therapeutic case series.