Purpose

The purpose of this study was to (1) identify risk factors associated with early election to proceed with subsequent cartilage transplantation after a staging chondroplasty within 6 months and (2) develop a risk calculator with pre-operative prognostic value for conversion.

Methods and Materials

A retrospective review of patients prospectively enrolled at the time of staging chondroplasty was performed, with early election defined as patient decision to proceed to cartilage transplantation within six months of chondroplasty. Cox proportional hazards analysis was used to determine univariate predictors of conversion, and a predictive calculator was formulated using stepwise regression employing the Akaike Information Criterion (AIC). Postoperative patient-reported outcomes were compared between failure and non-failure cohorts in the timepoints leading up to the mean decision time to validate that failure correlated with worse PROMs.

Results

Sixty-five patients (67 knees) were included for analysis, with an overall election rate of 29.9% within six months after chondroplasty. Based on multivariate results, the final AIC-driven CERT score employed preoperative KOOS Pain Score, VR12 Physical Score, condylar involvement, and AMADEUS score to generate 0–7-point risk stratification system with a 3% early election to proceed to transplant risk in the 0–2-point score group, 33% risk in the 3–4-point group, and 79% risk in the 5+ point group (p < 0.01) and an overall AUC of 0.906 (p<0.01). By 6 weeks, early electing patients demonstrated significantly worse pain (61.71±17.97 vs 77.03±14.79, p=.003), daily living (84.75±14.26 vs 67.55±20.69, p=.002), sports (57.36±22.94 vs 32.14±28.67, p=.002), and quality of life scores (49.31±21.27 vs 22.33±20.33, p=<.001).

Conclusion

The risk of a given patient electing to proceed with a cartilage restoration procedure within 6 months after failing to derive therapeutic benefit from staging chondroplasty is closely and additively associated with pre-operative KOOS Pain Score, VR12 Physical Score, anatomic area involved, and lesion AMADEUS score. 

Purpose

Proximal tibial osteotomy (PTO) is well-established for the treatment of coronal deformity and focal cartilage defects. However, the utility of joint preserving interventions must be weighed against potential effects on subsequent total knee arthroplasty (TKA). The purpose of this study was to determine the effect of PTO on subsequent TKA by robustly comparing outcomes in patients with bilateral TKAs following unilateral PTO.

Methods and Materials

Patients undergoing bilateral TKA between 2000–2015 at a single institution with previous unilateral valgus-producing PTO were reviewed. Knee Society Scores (KSS), Forgotten Joint Score 12 (FJS-12), subjective knee preference, and revision were compared between the PTO-TKA and contralateral TKA-only side.

Results

We evaluated 140 TKAs performed in 70 patients (24F, 46M) with unilateral PTO and subsequent bilateral TKA. Mean age at PTO was 50±8 years, with patients converting to TKA at a mean of 14±7 years following ipsilateral PTO and followed for a mean of 25±7 years (Range: 6–40).

PTOs demonstrated similar KSS (41±16) compared to their contralateral side (KSS: 39±16, p=0.67) immediately prior to arthroplasty. Patients had significant improvements in KSS (p<0.001) after TKA, with clinically similar KSS scores at 2–15 years of follow-up when comparing knees in a pairwise fashion (p>0.10). Five PTO-TKA knees (7%) and 4 control TKA-only knees (6%) underwent revision at a mean of 5 years postoperatively (p=0.76). A clinically relevant trend towards increased all-cause reoperation was observed in the PTO-TKA group (13% vs. 6%, p=0.24).

At final follow-up, PTO-TKA demonstrated similar FJS-12 scores (72±26) compared to the contralateral side (70±28, p=0.57). 19% of patients preferred their PTO-TKA knee, 19% preferred the contralateral knee, and 62% stated their knees were equivalent. Final Tegner activity score was 2.5±1.4.

Conclusion

Long-term clinical function of TKA following PTO is excellent, with comparable subjective outcomes and equivalent knee preference at 25 year follow-up compared to contralateral TKA-only knees.

Purpose

The purpose of this study was to describe a cohort of isolated medial meniscus posterior root tears (MMPRTs) and determine short-term clinical outcomes to 1) determine risk factors associated with clinical failures and 2) describe the surgical failure rates.

Methods and Materials

Isolated MMPRT repairs performed 2010-2019 at a single academic institution were reviewed. Clinical failure was defined as patients with International Knee Documentation Committee (IKDC) scores below the Patient Acceptable Symptomatic State (PASS) threshold of 75.9. Surgical failure was defined as root repair re-tear or conversion to arthroplasty. Additionally, pre-MMPRT and final Tegner activity level, pre- and postoperative Visual Analog Scale (VAS) were recorded.

Results

Fifty-one isolated MMPRT repairs (35 females, 16 males, age: 46±12 years, BMI: 31±7 kg/m2) were followed for a mean of 3.1 years (range: 1.2-6.5 years). Mean pre-MMPRT Tegner prior to onset of knee symptoms was 5.1±1.7 and mean immediate preoperative VAS was 4.0±2.7 at rest and 6.0±2.6 with use. Preoperative meniscus extrusion was 3.5±0.9 mm (range: 1.5–5.3). Patients achieved significant postoperative improvements in VAS (p<0.001) and were able to regain Tegner scores of 4.4±1.7, which was statistically similar to their pre-injury levels (p=0.65). At final follow-up, patients with a discrete injury event (HR: 0.39, p=0.02), <4 mm of preoperative extrusion (HR: 2.6 for ≥4 mm extrusion, p=0.03), and preoperative Tegner ≥4 (HR: 0.12, p=0.12) were more likely to meet the IKDC-PASS threshold of 75.9. Two patients (4%) experienced a root repair re-tear, and two patients (4%) converted to arthroplasty at a mean of 4.5 years postoperatively.

Conclusion

Transtibial repair of isolated MMPRTs demonstrates significant improvements in preoperative VAS pain scores and restoration of pre-injury Tegner activity scores. Patients’ ability to achieve a postoperative IKDC-PASS threshold of 74.9 points is predicted by a discrete tear event, preoperative extrusion <4 mm, and high pre-injury activity level.