Return to Sport Following High Tibial Osteotomy With Concomitant Osteochondral Allograft Transplantation

• Published in: The American journal of sports medicine Vol. 48; no. 8; pp. 1945 - 1952
• Main Authors: Liu, Joseph N., Agarwalla, Avinesh, Christian, David R., Garcia, Grant H., Redondo, Michael L., Yanke, Adam B., Cole, Brian J.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-07-2020; Sage Publications Ltd
• Subjects: Defects; Knee; Patient satisfaction; Questionnaires; Recovery of function; Sports medicine; return to sports; osteochondral allograft transplantation; cartilage restoration; high tibial osteotomy; varus deformity
• ISSN: 0363-5465; 1552-3365
• DOI: 10.1177/0363546520920626

Background:
Young patients with symptomatic chondral defects in the medial compartment with varus malalignment may undergo opening wedge high tibial osteotomy (HTO) with concomitant osteochondral allograft transplantation (OCA) (HTO + OCA). Although patients have demonstrated favorable outcomes after HTO + OCA, limited information is available regarding return to sporting activities after this procedure.
Purpose:
To evaluate (1) the timeline to return to sports (RTS), (2) patient satisfaction, and (3) reasons for discontinuing sporting activity after HTO + OCA, and to identify predictive factors of RTS.
Study Design:
Case series; level of evidence, 4.
Methods:
Consecutive patients who underwent HTO + OCA for varus deformity and medial femoral condyle focal chondral defects with a minimum 2-year follow-up were retrospectively reviewed. Patients completed a subjective sports questionnaire, satisfaction questionnaire, visual analog scale for pain, and Single Assessment Numerical Evaluation.
Results:
Twenty-eight patients with a mean age of 36.97 ± 7.52 years were included at mean follow-up of 6.63 ± 4.06 years. Fourteen patients (50.0%) required reoperation during the follow-up period, with 3 (10.7%) undergoing knee arthroplasty. Twenty-four patients participated in sports within 3 years before surgery, with 19 patients (79.2%) able to return to at least 1 sport at a mean 11.41 ± 6.42 months postoperatively. However, only 41.7% (n = 10) were able to return to their preoperative level. The most common reasons for sports discontinuation (n = 20; 83.3%) were a desire to prevent further damage to the knee (70.0%), persistent pain (55.0%), persistent swelling (30.0%), and fear (25.0%).
Conclusion:
In young, active patients with varus deformity and focal medial femoral condyle chondral defects, HTO + OCA enabled 79.2% of patients to RTS by 11.41 ± 6.42 months postoperatively. However, only 41.7% of patients were able to return to their preinjury level or better. It is imperative that patients be appropriately educated to manage postoperative expectations regarding sports participation after HTO + OCA.