gms | German Medical Science

Objectives: Deep osteochondral defects of the medial femoral condyle in young and active patients are a severe condition, which might lead to early osteoarthritis of the knee joint. Concomitant varus malalignment most likely promotes this process due to overloading of the medial compartment. Purpose of this study was the evaluation of long-term results and analysis of survival rates (conversion to knee joint arthroplasty) after combined OAT and valgus HTO in young and active patients with symptomatic osteochondral defects of the medial femoral condyle and concomitant varus malalignment.

Methods: Between 1998 and 2008 combined OAT and valgus HTO was performed in 86 patients with deep osteochondral defects of the medial femoral condyle and concomitant varus malalignment > 2° without ligamentous instability, previous ACL or PCL reconstruction, additional meniscal-repair/-transplantation oxr general osteoarthritis. 57 patients were available for evaluation (preliminary follow-up rate 77% of 10 year follow up, evaluation ongoing until March 2023). The mean age at surgery was 37 years and the mean follow-up time was 21.4 years (14–25 years). Knee function was assessed using the Lysholm score and pain intensity was measured using the Visual Analogue Scale (VAS). The survival-rates of this combined procedure were evaluated. Failure was defined as conversion to knee joint arthroplasty during the follow-up period.

Results and conclusion: Adjusted to follow-up time, the Lysholm score showed a mean increase of 31 points from 40 to 71 (p <0.001) , representing a significant improvement compared to preoperatively. The VAS decreased by a mean of 4.7 points from 7.5 to 2.6 (p<0.001); and 82% of the patients were satisfied with the results of the operation. The survival-rate at follow up was 86% years after surgery.

Combined OAT and valgus HTO are a promising option to treat patients with severe osteochondral defects of the medial femoral condyle and concomitant varus malalignment. Significant improved knee function, decreased pain intensity and a high survival-rate can often be expected after 20 years.