Objective To compare the effectiveness of arthroscopic osteochondral autologous transplantation (OAT) in the treatment of young and middle-aged patients with the articular cartilage injury. MethodsA clinical data of 43 patients (43 knees) with articular cartilage injury, who underwent OAT between January 2008 and August 2016, was retrospectively analyzed. There were 23 patients aged 20-40 years (young group) and 20 patients aged 40-60 years (middle-aged group). The difference in age between the two groups was significant (t=14.120, P=0.001). There was no significant difference in gender, body mass index, complications, affected side, lesion site, lesion area, and the International Cartilage Repair Society (ICRS) grade of cartilage injury between the two groups (P>0.05). The function of knee joint was evaluated by Lysholm score and International Knee Documentation Committee (IKDC) score during the follow-up. MRI examination was performed to observe the repair of both receiving and the donor sites. ResultsAll the incisions in the two groups were healed by first intention. All patients in the two groups were followed up with an average of 3.6 years (range, 2-8 years). At 2 years after operation, the Lysholm and IKDC scores were significantly improved in the two groups when compared with the preoperative scores (P<0.05). The Lysholm and IKDC scores in the young group were significantly better than those in the middle-aged group before operation and at 2 years after operation (P<0.05). However, there was no significant difference in the differences of the Lysholm and IKDC scores between pre- and post-operation between the two groups (P>0.05). The MRI examination at 2 years after operation showed that both receiving and the donor sites healed well in the two groups. ConclusionAccording to the texture, thickness, elasticity, and lesion area of the cartilage, arthroscopic OAT might be the first choice for the articular cartilage injury in middle-aged patients and can obtain the satisfactory short-term effectiveness.
Objective To investigate the short-term effectiveness of high tibial osteotomy (HTO) for treatment of middle aged and older populations with varus knee combined with medial meniscus posterior root tear (MMPRT), and to evaluate the biomechanical changes in the knee joint after operation based on finite element analysis. Methods A retrospective analysis of clinical data was conducted on 35 patients (35 knees) admitted between June 2021 and October 2023, who met the inclusion criteria for varus knee combined with MMPRT. There were 17 males and 18 females with a mean age of 59.2 years (range, 48-65 years). Open wedge HTO was performed to correct the alignment in all patients. X-ray films and MRI were conducted before operation and at 3, 6, and 12 months after operation to assess changes in lower limb alignment and joint structure. And the femorotibial angle, medial proximal tibial angle (MPTA), posterior tibial slope angle (PTSA), weight-bearing line ratio (WBLR), as well as the Lysholm score, Hospital for Special Surgery (HSS) score, and visual analogue scale (VAS) score for pain were compared between pre- and post-operation. Finite element models were reconstructed based on knee CT data from a healthy volunteer to simulate changes in stress distribution at the knee joint before and after HTO, and to analyze postoperative mechanical improvement characteristics. Results All 35 patients underwent successful operations. Postoperatively, 3 cases of incisional fat liquefaction and 2 cases of mild superficial wound infection occurred; no complication such as deep vein thrombosis of the lower extremities, severe infection, or neurovascular injury was observed. All patients were followed up 12-14 months (mean, 13.0 months). Imaging reexamination revealed that all osteotomies had achieved radiographic union, with no complication such as osteotomy loss, significant collapse, or plate fracture. At 12 months after operation, the femorotibial angle, MPTA, WBLR, and PTSA were all significantly higher than preoperative levels (P<0.05). Compared with preoperative values, the Lysholm score and HSS score gradually increased, while the VAS score decreased at 3, 6, and 12 months, with significant differences between different time points (P<0.05). Finite element analysis showed that the stress distribution in the medial and lateral compartments of the knee joint tended toward equilibrium after HTO. Medial cartilage contact stress decreased by approximately 40% compared to preoperative levels, and stress concentration in the medial meniscus was significantly reduced. Conclusion HTO can significantly alleviate knee pain in middle aged and older populations with varus knee combined with MMPRT, improve the distribution of knee joint forces, and promote the recovery of joint function.
