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Chondral Resurfacing and High Tibial Osteotomy in the Varus Knee

Background Treatment of patients with degenerative knees and varus malalignment presents a difficult clinical problem. Hypothesis Combining a medial opening wedge high tibial osteotomy with the microfracture chondral resurfacing procedure is a viable treatment option. Study Design Retrospective review of prospectively collected data. Methods A group of 38 consecutive patients (mean age, 51.3 years; range, 34 to 72 years; 29 men and 10 women) with varus malalignment and chondral lesions who were treated with chondral resurfacing (an abrasion and microfracture technique) combined with a medial opening wedge high tibial osteotomy. All patients had >5° of varus malalignment. Patients were evaluated preoperatively with the Lysholm and Western Ontario & McMasters Universities Osteoarthritis Index scoring systems and at a minimum of 2 years follow-up. Results Thirty-three of 38 patients (87%) were available for 2-year follow-up (average, 45 months; range, 24 to 80 months). Lysholm scores improved from a preoperative score of 43.5 to 78.0 at follow-up; Western Ontario & McMasters Universities Osteoarthritis Index scores improved from 45.8 to 16.2. The average Tegner score was 5.0. Conclusions Combining a medial opening wedge high tibial osteotomy with the microfracture chondral resurfacing procedure in the varus knee is an effective method of decreasing pain and increasing function at a minimum of 2 years follow-up.