Background:Osteochondral defects of the medial femoral condyle combined with varus malalignment in young and active patients are a debilitating condition, which can result in early osteoarthritis. Osteochondral autologous transfer (OAT) combined with valgus high tibial osteotomy (HTO) might therefore be a comprehensive solution to maintain long-term knee function.Purpose/Hypothesis:The purpose of this study was to report clinical results and survivorship after combined OAT and valgus HTO for symptomatic osteochondral defects of the medial femoral condyle in the setting of varus malalignment at a long-term follow-up. It was hypothesized that undergoing combined OAT and valgus HTO would produce favorable clinical results along with a low rate of conversion to arthroplasty.Study Design:Case series; Level of evidence, 4.Methods:All patients treated between 1998 and 2008 with combined valgus HTO and OAT for deep osteochondral defects of the medial femoral condyle and concomitant varus malalignment >2° without meniscal repair/transplantation, osteoarthritis, or ligamentous instability/reconstruction were included. The survival rates of this combined procedure were evaluated. Failure was defined as conversion to knee joint arthroplasty during the follow-up period. Patient-reported outcomes were collected pre- and postoperatively, including the Lysholm score, visual analog scale score, Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner Activity Scale score, and subjective level of satisfaction (scale 0-10).Results:Of 74 patients who were included for 10-year follow-up, 3 had died. A total of 15 patients were lost to follow-up, so 56 patients could be reevaluated, for a follow-up rate of nearly 80%. The mean age at surgery was 38.8 ± 9.9 years (range, 19.9-62.4 years), and the mean follow-up time was 18.9 ± 3.0 years (median, 18.8 years; range, 14.1-24.8 years). The survival rates were 87% at 10 years, 86% at 15 years, and 77% at 19 years after surgery. At final follow-up, the Lysholm score showed a mean increase of 39 points (95% CI, 25.4-50.0 points; P < .001) from 40 points to 79 points, representing a significant improvement. Overall, 96% of patients surpassed the minimal clinically important difference (MCID) for the Lysholm score. The visual analog scale score decreased by a mean of 4.8 points (range, 5-10 points) from 7.5 points to 2.7 points ( P < .001), and 80% of patients surpassed the MCID. The mean Tegner Activity Scale score was 4.5 ± 1.6, and the mean KOOS subscale scores at final follow-up were as follows: Pain: 81 ± 21 (range, 19-100), Symptoms: 80 ± 22 (range, 21-100), Activities of Daily Living: 85 ± 21 (range, 18-100), Sports: 68 ± 32 (range, 0-100), and Quality of Life: 67 ± 28 (range, 0-100). Overall, 78% of the patients were satisfied with the results of the operation.Conclusion:The combination of OAT and valgus HTO presents a viable treatment option for patients affected by osteochondral defects of the medial femoral condyle and concurrent varus malalignment. A sustained and substantial improvement in clinical outcomes, significantly reduced pain severity, and a high rate of long-term survivorship can be anticipated in the long-term follow-up.

中文翻译：

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骨软骨自体转移联合外翻胫骨高位截骨术后临床结局及远期生存率 56 例患者 19 年后的分析


背景： 年轻和活跃患者股骨髁内侧骨软骨缺损合并内翻错线不良是一种使人衰弱的疾病，可导致早期骨关节炎。因此，骨软骨自体转移术 （OAT） 结合外翻胫骨高位截骨术 （HTO） 可能是维持长期膝关节功能的综合解决方案。目的/假设： 本研究的目的是在长期随访中报告 OAT 和外翻 HTO 联合治疗内翻对线不良情况下股骨髁症状性骨软骨缺损后的临床结果和生存率。据推测，接受 OAT 和外翻 HTO 联合治疗会产生良好的临床结果，并且向关节置换术的转化率较低。研究设计： 病例系列;证据水平， 4.方法： 纳入 1998 和 2008年接受外翻 HTO 和 OAT 联合治疗股骨内侧髁深部骨软骨缺损和伴随内翻错位 >2° 无半月板修复/移植、骨关节炎或韧带不稳定/重建的患者。评估了这种联合手术的存活率。失败定义为在随访期间转为膝关节置换术。收集患者术前和术后报告的结果，包括 Lysholm 评分、视觉模拟量表评分、膝关节损伤和骨关节炎结果评分 （KOOS）、Tegner 活动量表评分和主观满意度 （量表 0-10）。结果： 在纳入 10 年随访的 74 例患者中，3 例死亡。共有 15 名患者失访，因此可以重新评估 56 名患者，随访率接近 80%。手术时的平均年龄为 38.8 ± 9.9 岁 （范围，19.9-62 岁。4 年），平均随访时间为 18.9 ± 3.0 年 （中位数为 18.8 年;范围为 14.1-24.8 年）。术后 10 年生存率为 87%，15 年为 86%，19 年为 77%。在最终随访时，Lysholm 评分显示平均增加 39 分 （95% CI，25.4-50.0 分;P < .001） 从 40 分降至 79 分，表示有显著改善。总体而言，96% 的患者超过 Lysholm 评分的最小临床重要差异 （MCID）。视觉模拟量表评分从 7.5 分平均下降 4.8 分 （范围，5-10 分） 至 2.7 分 （P < .001），80% 的患者超过了 MCID。平均 Tegner 活动量表评分为 4.5 ± 1.6，最终随访时的平均 KOOS 分量表评分如下：疼痛：81 ± 21（范围，19-100），症状：80 ± 22（范围，21-100），日常生活活动：85 ± 21（范围，18-100），运动：68 ± 32（范围，0-100）和生活质量：67 ± 28（范围，0-100）。总体而言，78% 的患者对手术结果感到满意。结论： OAT 联合外翻 HTO 为股骨内侧髁骨软骨缺损和并发内翻错线不良患者提供了一种可行的治疗选择。在长期随访中，可以预期临床结果的持续和实质性改善，疼痛严重程度显著降低，长期生存率高。