Do microfractures improve high tibial osteotomy outcome?

The aim of this study was to determine if microfractures improve the outcome of high tibial osteotomy in patients with medial compartmental osteoarthritis in genu varum. Forty patients presenting with Outerbridge grade III and IV chondropathies on the femoral and/or the tibial joint surface underwent high tibial osteotomy with Puddu plates (Arthrex, Inc, Naples, Florida) for primary medial compartment osteoarthritis in genu varum at our institution. Patients were randomly assigned to either the high tibial osteotomy plus microfractures group (A; n=20) or the high tibial osteotomy alone group (B; n=20). Final assessment was conducted 5 years postoperatively, including clinical response measured by the International Knee Documentation Committee (IKDC), Lysholm score, and patient satisfaction score. All patients were blinded to the treatment received and followed the same rehabilitation protocol. A statistically significant improvement between pre- and postoperative values was observed for Lysholm and IKDC scores in both groups, without any statistically significant difference between them. Regarding the satisfaction score, there were no differences between the 2 groups in terms of preoperative self-assessment (P>.05), whereas postoperative subjective satisfaction at 5-year follow-up was significantly higher in group A than in group B (P=.0036). Our study results provide further evidence that medial tibial osteotomy is an effective surgical option for treating a varus knee associated with medial degenerative arthritis in patients wishing to continue accustomed levels of physical activity. In particular, patient satisfaction was higher among those who underwent the combined treatment involving high tibial osteotomy to correct femorotibial angle and microfractures.