Effects of concurrent cartilage procedures on cartilage regeneration in high tibial osteotomy: a systematic review

Abstract

Purpose: This systematic review aimed to evaluate the effects of concurrent cartilage procedures on cartilage regeneration when performed alongside high tibial osteotomy (HTO). Materials and methods: The systematic review followed the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). A comprehensive search was conducted on databases including PubMed, Embase, Cochrane Library, and Google Scholar, covering articles published until August 31, 2023. Results: Sixteen studies (1277 patients) revealed that HTO, with or without concurrent cartilage procedures, leads to cartilage regeneration based on the International Cartilage Repair Society (ICRS) grade during second-look arthroscopy. No concurrent procedure showed improvement in ICRS grade (mean difference: − 0.80 to − 0.49). Microfracture (mean difference: − 0.75 to − 0.22), bone marrow aspirate concentrate (BMAC) (mean difference: − 1.37 to − 0.67), and human umbilical cord blood-derived mesenchymal stem cell (hUCB-MSC) (mean difference: − 2.46 to − 1.81) procedures also demonstrated positive outcomes. Clinical outcome assessments for each cartilage procedure were also improved during postoperative follow-up, and no specific complications were reported. Conclusions: HTO with or without concurrent cartilage procedures promotes cartilage regeneration observed during second-look arthroscopy, with improved clinical outcomes. Future randomized controlled trials on the same topic, along with subsequent meta-analyses, are necessary for conclusive findings.