Effects of concurrent cartilage procedures on cartilage regeneration in high tibial osteotomy: a systematic review

Abstract

Abstract Purpose This systematic review aimed to evaluate the effects of concurrent cartilage procedures on cartilage regeneration when performed alongside high tibial osteotomy (HTO). Materials and methods The systematic review followed the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). A comprehensive search was conducted on databases including PubMed, Embase, Cochrane Library, and Google Scholar, covering articles published until August 31, 2023. Results Sixteen studies (1277 patients) revealed that HTO, with or without concurrent cartilage procedures, leads to cartilage regeneration based on the International Cartilage Repair Society (ICRS) grade during second-look arthroscopy. No concurrent procedure showed improvement in ICRS grade (mean difference: − 0.80 to − 0.49). Microfracture (mean difference: − 0.75 to − 0.22), bone marrow aspirate concentrate (BMAC) (mean difference: − 1.37 to − 0.67), and human umbilical cord blood-derived mesenchymal stem cell (hUCB-MSC) (mean difference: − 2.46 to − 1.81) procedures also demonstrated positive outcomes. Clinical outcome assessments for each cartilage procedure were also improved during postoperative follow-up, and no specific complications were reported. Conclusions HTO with or without concurrent cartilage procedures promotes cartilage regeneration observed during second-look arthroscopy, with improved clinical outcomes. Future randomized controlled trials on the same topic, along with subsequent meta-analyses, are necessary for conclusive findings.

Keywords

• High tibial osteotomy
• Human umbilical cord blood-derived mesenchymal stem cell
• Bone marrow aspirate concentrate
• Microfracture
• Cartilage regeneration
• Second-look arthroscopy