The role of microfractures with tibial osteotomy in the treatment of knee osteoarthritis with a varus deformity

Souza, Leonardo Antunes Bellot de; Rocha, Vinícius Magno da; Ramos, Max Rogerio Freitas

doi:10.1016/j.rboe.2017.08.023

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Artigos Originais • Rev. bras. ortop. 53 (6) • Nov-Dec 2018 • https://doi.org/10.1016/j.rboe.2017.08.023 copy

The role of microfractures with tibial osteotomy in the treatment of knee osteoarthritis with a varus deformity^☆ ☆ Study conducted at Hospital Universitário Gaffrée e Guinle, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To evaluate the microfracture intervention with tibial valgus osteotomy associated in the treatment of varus gonarthrosis.

Methods:

From November 2005 to May 2013, 129 patients with medial gonarthrosis, varus deformity (8°-12°), and range of movement greater than 90° were evaluated. Patients with advanced gonarthrosis (Alhbäck 3, 4, and 5), Outerbridge lesion inferior to IV, previous knee surgery, body mass index greater than 35 kg/m², and/or cruciate ligament injuries were not included. All patients were treated with videoarthroscopy followed by tibial valgus osteotomy. In the group osteotomy associated with microfracture (n = 56, mean age = 39.3), tibial valgus osteotomy and microfracture techniques to address chondral defects were used. In the isolated osteotomy group (n = 73, mean age = 41.4), only this procedure was performed. Post-surgical follow-up was 24 months, with four evaluations in the first 6 months, proceeding to biannual twice-a-year evaluation in the subsequent period. The Lysholm scale was used for functional monitoring.

Results:

There was a significant improvement in the pain, limping, and squatting domains of the Lysholm scale but only in the isolated osteotomy group. A greater variance of results was observed in the osteotomy group associated to microfracture, in addition to an increased risk of functional deterioration (OR = 8.64).

Conclusion:

The association of microfractures and tibial valgus osteotomy was correlated to lower functional outcomes than tibial valgus osteotomy alone, and may be related to the risk of worsening in the first two postoperative years.

Keywords:
Knee osteoarthritis; Genu varum; Osteotomy; Arthroscopy; Lysholm knee score

Inclusion criteria	Exclusion criteria
Medial gonarthrosis	Advanced gonarthrosis
(Alhback 1 and 2)	(Alhback 3, 4, and 5)
Genu varum between 8° and 10°	Prior surgery in the joint
Range of motion >90°	Body mass index >35 kg/m²
Age between 18 and 70 years	Injury of crossed ligaments

Lysholm	Statistics	Isolated TVO group				TVO + microfracture group
		Preop	6th m	12th m	18th m	Preop	6th m	12th m	18th m
Limping	Mean	3.4	4.8	4.8	4.8	3.5	4.2	4.2	4.2
	Md.	3	5	5	5	3	5	5	5
	σ	0.8	0.6	0.6	0.6	0.9	1.1	1.1	1.1
	Min.	3	3	3	3	3	0	0	0
	Max.	5	5	5	5	4	5		5
	CV	0.24	0.11	0.11	0.12	0.25	0.27	0.26	0.27
Support	Mean	4.8	4.9	4.9	4.8	4.1	4.7	4.7	4.6
	Md.	5	5	5	5	5	5	5	5
	σ	0.8	0.4	0.4	0.7	1.1	0.9	0.9	1
	Min.	2	2	2	2	2	2	2	2
	Max.	5	5	5	5	5	5	5	5
	CV	0.17	0.09	0.09	0.15	0.24	0.2	0.2	0.22
Locking	Mean	7.3	14.2	14.3	14.2	8.6	13.9	13.9	13.7
	Md.	6	15	15	15	10	15	15	15
	σ	2.7	1.9	1.7	1.9	2.6	2.4	2.4	2.5
	Min.	2	10	10	10	6	6	6	6
	Max.	10	15	15	15	15	15	15	15
	CV	0.37	0.13	0.12	0.13	0.3	0.17	0.17	0.18
Instability	Mean	17.1	23.8	23.8	23.8	18.5	23.1	23.1	23.1
	Md.	20	25	25	25	20	25	25	25
	σ	3.5	2.2	2.1	2.1	2.7	3.8	3.8	3.8
	Min.	10	20	20	20	15	10	10	10
	Max.	20	25	25	25	25	25	25	25
	CV	0.21	0.09	0.09	0.09	0.15	0.16	0.16	0.16
Pain	Mean	13.2	21.7	21.8	21.7	13.3	19.7	19.3	19.2
	Md.	15	20	20	20	15	20	20	20
	σ	2.7	3.8	3.9	4	2.4	5.1	5.3	5.4
	Min.	10	10	10	10	10	5	5	5
	Max.	15	25	25	25	15	25	25	25
	CV	0.2	0.18	0.18	0.18	0.18	0.26	0.28	0.28
Swelling	Mean	6.3	9.3	9.3	9.5	7.6	9.1	8.8	8.7
	Md.	6	10	10	10	6	10	10	10
	σ	2.9	1.7	1.6	1.5	2.5	1.8	2	2
	Min.	2	2	2	2	2	2	2	2
	Max.	10	10	10	10	10	10	10	10
	CV	0.46	0.18	0.17	0.16	0.33	0.2	0.23	0.23
Climbing stairs	Mean	5.9	8.1	8.6	8.8	6	7.9	8.1	8.2
	Md.	6	10	10	10	6	10	10	10
	σ	0.7	2	1.9	1.8	0.76	2.3	2.3	2.3
	Min.	2	6	6	6	2	2	2	2
	Max.	6	10	10	10	10	10	10	10
	CV	0.11	0.25	0.22	0.21	0.13	0.29	0.28	0.28
Squatting	Mean	3.3	4.7	4.7	4.7	3.5	4.4	4.4	4.5
	Md.	4	5	5	5	4	5	5	5
	σ	1.1	0.7	0.7	0.7	0.9	0.9	0.9	0.8
	Min.	2	2	2	2	2	2	2	2
	Max.	4	5	5	5	4	5	5	5
	CV	0.34	0.16	0.16	0.16	0.26	0.2	0.2	0.17
Total value	Mean	60.8	91.5	92.3	92.3	65.5	87.1	86.5	86.3
	Md.	64	95	95	95	67	90	89	89
	σ	7	7.7	8	8.8	5.2	12.1	12.7	12.8
	Min.	46	65	65	62	51	48	48	50
	Max.	70	100	100	100	73	100	100	100
	CV	0.12	0.08	0.09	0.09	0.08	0.14	0.15	0.15

Lysholm scale domains	6th month	12th month	18th month
Limping	0	0	0
Support	0.059	0.059	0.261
Locking	0.579	0.329	0.297
Instability	0.659	0.539	0.539
Pain	0.023	0.006	0.006
Swelling	0.637	0.066	0.007
Climbing stairs	0.713	0.329	0.159
Squatting	0.024	0.009	0.018
Total score	0.022	0.004	0.002

First evaluation (6th month)
	Second evaluation (12th month)
	Excellent	Good	Regular	Total
Excellent	39	0	0	39
	53.40%	0.00%	0.00%	53.40%
Good	6	17	1	24
	8.20%	23.30%	1.40%	32.90%
Regular	0	0	10	10
	0.00%	0.00%	13.70%	13.70%
Total	45	17	11	73
	61.60%	23.30%	15.10%	100.00%

First evaluation (6th month)
	Second evaluation (12th month)
	Excellent	Good	Regular	Poor	Total
Excellent	19	0	0	0	19
	33.90%	0.00%	0.00%	0.00%	33.90%
Good	1	20	5	0	26
	1.80%	35.70%	8.90%	0.00%	46.40%
Regular	0	0	7	0	7
	0.00%	0.00%	12.50%	0.00%	12.50%
Poor	0	0	0	4	4
	0.00%	0.00%	0.00%	7.20%	7.20%
Total	20	20	12	4	56
	35.70%	35.70%	21.40%	7.20%	100.00%

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[1] *Corresponding author. E-mail: maxramos@ig.com.br (M.R. Ramos).

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The role of microfractures with tibial osteotomy in the treatment of knee osteoarthritis with a varus deformity☆ ☆ Study conducted at Hospital Universitário Gaffrée e Guinle, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.

ABSTRACT

Objective:

Methods:

Results:

Conclusion:

The role of microfractures with tibial osteotomy in the treatment of knee osteoarthritis with a varus deformity^☆ ☆ Study conducted at Hospital Universitário Gaffrée e Guinle, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.