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Institut du mouvement et de l’appareil locomoteur, Marseille, France
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Varus knees with associated cartilage pathologies are not uncommon scenarios that present to orthopaedic surgeons.
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There is no agreement on the ideal management of varus knees with concomitant cartilage pathology.
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Through a literature review, the authors tried to answer three main questions:
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On October 2022, OVID MEDLINE, EMBASE, and COCHRANE databases were searched. Clinical studies reporting on clinical, radiologic, or macroscopic cartilage regeneration following either isolated knee osteotomy or concomitant osteotomy and a cartilage procedure were reviewed.
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Despite controversies, the literature demonstrated favourable outcomes of combined knee osteotomy and a cartilage procedure in patients with substantial deformity and cartilage defects.
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Isolated high tibial osteotomy may induce cartilage regeneration in several scenarios and severities of concomitant malalignment and cartilage defects.
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There are recommendations that knee osteotomy should be added to a cartilage procedure when an extra-articular deformity of > 5° is detected.
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Some studies report good outcomes for combining a knee osteotomy with cartilage grafting, but they lack a control group of isolated osteotomy.
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There is still scarce of evidence on the influence of osteotomies on cartilage regeneration and the outcomes of concomitant osteotomy and different cartilage procedures vs isolated osteotomies.
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With advanced statistical evaluation (artificial intelligence, machine learning) of big datasets, more answers and better results will be delivered.
