Return to Sport and Patient Satisfaction Following Concomitant High Tibial Osteotomy and Osteochondral Allograft Transplantation
Authors: Liu Joseph N. , Christian David R. , Agarwalla Avinesh , Garcia Grant H. , Redondo Michael L. , Yanke Adam Blair , Cole Brian J. 
Published: March 2019

Objectives:

Varus deformity of the knee predisposes patients to chondral and meniscal pathology of the medial compartment. Young patients with symptomatic chondral defects of the medial femoral with varus alignment often undergo concomitant opening wedge high tibial osteotomy (HTO) and cartilage restoration including allograft transplantation (OCA). Limited information is available regarding return to sporting activities after combined HTO and osteochondral allograft transplantation (OCA).

Methods:

All patients who underwent concomitant HTO and OCA by a single surgeon for medial knee pain due to a focal chondral defect of the medial femoral condyle were retrospectively identified through a prospectively collected data base. The primary indication for HTO was varus malalignment ≥ 5 degrees. At final follow-up, patients completed a subjective sports questionnaire, the Marx activity scale, a pain visual analog scale (VAS), a Single Assessment Numerical Evaluation (SANE), and a satisfaction questionnaire. Patients were excluded for having undergone any concomitant procedure other than cartilage restoration or < 2 years of follow-up.

Results:

Of 39 concomitant HTO and OCA patients, 28 (71.8%) were available for follow-up at an average 6.07 +/- 4.09 years (range: 2-13 years). The average age at the time of surgery was 35.8 +/- 8.2 years, and 22 patients (78.6%) of patients were male. Four patients (14.3%) also underwent a concomitant medial meniscal allograft transplantation. Nearly all patients had undergone a prior ipsilateral knee surgery (26 patients, 92.8%). Reoperation was performed in 14 patients (50.0%) by the time of final follow-up for persistent symptoms: 6 patients received a meniscal debridement/meniscectomy, 2 patients received a total knee replacement, 1 patient received a unicompartmental knee arthroplasty, 4 patients underwent hardware removal, and 1 patient underwent autologous chondrocyte implantation of a new defect. Of the 22 patients who participated in sports within 3 years prior to their HTO + OAG, 18 patients (67.9%) returned to sport at an average of 11.4 +/- 6.4 months following operative management; however, only 35.7% of patients were able to return to their pre-injury level. Additionally, 60.7% of patients reported being satisfied or extremely satisfied with their return to sport activity. The most common reasons for discontinuing sports were: to prevent further damage (62.5%), persistent pain (54.2%), persistent swelling (33.3%), and fear of further injury (20.8%). Specific sports had high direct rates of return to sport: golf (100%), cross-fit/high-intensity (83.3%), cycling (88.9%), heavy-weightlifting (100%), swimming (60%), running (44.4%) (Figure 1).

Conclusion:

In a young and active population, concomitant HTO and OA provides a high rate of return to sport 11.4 months postoperatively, although only 35.7% could return to preinjury level or better. Additionally, at an average of 6.07 years following the index procedure, 60.7% of patients were satisfied regarding their sports and activities. When indicated, concomitant HTO and OCA may provide good results in young and active patients who wish to resume sports and physical activities.