Comparison of Clinical Outcome following Cartilage Repair for Patients with Underlying Varus Deformity with or without Additional High Tibial Osteotomy: A Propensity Score–Matched Study Based on the German Cartilage Registry (KnorpelRegister DGOU)

Background. Even though realignment procedures have gained popularity as concomitant techniques in cartilage repair approaches with underlying malalignment, the clinical efficacy has not been proven to full extent. Methods. Out of 5474 patients from the German Cartilage Registry, 788 patients with focal cartilage defects on the medial femoral condyle having received either no accompanying surgery or high tibial osteotomy (HTO) were identified. After a 1:1 propensity score matching, outcome of 440 patients was evaluated using KOOS (Knee Injury and Osteoarthritis Outcome Score), VAS (visual analogue scale), and satisfaction during the 3-year follow-up. Results. Patients having received a concomitant HTO had significantly higher postoperative KOOS values (12 months: 67.26 +/- 15.69 vs.75.10 +/- 16.12, P = 0.001; 24 months: 67.14 +/- 23.85 vs. 77.11 +/- 16.50, P = 0.010; 36 months: 74.40 +/- 16.57 vs. 81.75 +/- 14.22, P = 0.023) and lower pain levels (6 months: 3.43 +/- 2.18 vs. 2.89 +/- 2.15, P = 0.009; 12 months: 3.64 +/- 2.20 vs. 2.17 +/- 1.96, P < 0.001; 24 months: 4.20 +/- 3.12 vs. 2.94 +/- 2.45, P = 0.005; 36 months: 3.20 +/- 2.18 vs. 2.02 +/- 1.98, P = 0.003). One and 3 years postoperatively, concomitant HTO led to significantly higher satisfaction in patients. These advantages of accompanying HTO were also seen in the group of patients with a varus deformity of 5 degrees or more, in which pain levels without concomitant HTO even increased during the 3-year follow-up. Conclusion. The results of the present study underline the importance and safety of concomitant HTO in patients with cartilage defects and varus deformity. HTO should therefore be considered and recommended generously in patients with focal cartilage defects of the medial femoral condyle and varus deformity

Does Gender Influence Outcome in Cartilage Repair Surgery? An Analysis of 4,968 Consecutive Patients from the German Cartilage Registry (Knorpel Register DGOU)

The goal was to examine gender differences of patient characteristics and outcome after cartilage repair based on a collective of nearly 5,000 patients. Patient characteristics, accompanying therapies, and outcome (Knee Injury and Osteoarthritis Outcome Score [KOOS], reoperations, patient satisfaction) of 4,986 patients of the German cartilage register DGOU were assessed by t test for possible gender differences. P values <0.05 were considered statistically significant. Women were older than men (38.07 +/- 12.54 vs. 26.94 +/- 12.394 years, P = 0.002), more often preoperated (0.30 +/- 0.63 vs. 0.24 +/- 0.55, P = 0.001), and had a longer symptom duration (25.22 +/- 41.20 vs. 20.67 +/- 35.32 months, P < 0.001). Men had greater mean leg axis malalignment than women (3.24 degrees +/- 3.26 degrees vs. 2.67 degrees +/- 3.06 degrees, P < 0.001), less favorable meniscal status (P = 0.001), worse defect stage (P = 0.006), and a more severely damaged corresponding articular surface (P = 0.042). At baseline (59.84 +/- 17.49 vs. 52.10 +/- 17.77, P < 0.001), after 6 months (72.83 +/- 15.56 vs. 66.56 +/- 17.66, P < 0.001), after 12 months (77.88 +/- 15.95 vs. 73.07 +/- 18.12, P < 0.001), and after 24 months (79.311 +/- 15.94 vs. 74.39 +/- 18.81, P < 0.001), men had better absolute KOOS values, but women had better relative KOOS increases 6 months (14.59 +/- 17.31 vs. 12.49 +/- 16.3, P = 0.005) as well as 12 months postoperatively (20.27 +/- 18.6 vs. 17.34 +/- 17.79, P = 0.001) compared with preoperatively, although 12 and 24 months postoperatively they were subjectively less satisfied with the outcome (P < 0.001) and had a higher reintervention rate at 24 months (0.17 +/- 0.38 vs. 0.12 +/- 0.33, P = 0.008). In summary, the present work shows specific gender differences in terms of patient characteristics, defect etiology, defect localization, concomitant therapy, and the choice of cartilage repair procedure. Unexpectedly, contrary to the established scientific opinion, it could be demonstrated that women show relatively better postoperative KOOS increases, despite a higher revision rate and higher subjective dissatisfaction