Simultaneous arthroscopic implantation of autologous chondrocytes and high tibial osteotomy for tibial chondral defects in the varus knee Francesco Franceschi a , Umile Giuseppe Longo a , Laura Ruzzini a , Andrea Marinozzi a , Nicola Maffulli b, ⁎ , Vincenzo Denaro a a Department of Orthopaedic and Trauma Surgery, Campus Biomedico University, Via Alvaro del Portillo, 200, 00128 Rome, Italy b Department of Trauma and Orthopaedic Surgery, University Hospital of North Staffordshire, Keele University School of Medicine, Stoke on Trent, ST4 7LN United Kingdom Received 4 November 2007; received in revised form 16 April 2008; accepted 18 April 2008 Abstract There is no consensus on the ideal management of patients with chondral defects of the medial tibial plateau and varus malalignment of the knee. We performed a cohort study to evaluate the outcome of patients affected by these conditions, who underwent arthroscopic implantation of autologous chondrocytes and a medial opening wedge high tibial osteotomy. Eight patients (four men and four women; mean age, 50 years, range: 42 to 58) with chondral defects of the medial tibial plateau in a varus knee underwent arthroscopic implantations of autologous chondrocytes in conjunction with a medial opening wedge osteotomy. At final post-operative follow up of 28 months following the index procedure, the post- operative scores were improved for the IKDC score (four patients abnormal and four patients severely abnormal to four patients normal, three patients nearly normal and one patient abnormal), Lysholm score (65.7 range 49–88 to 94.6 range89–100), Tegner score (3.7 range3–5 to 7 range 5–8) and VAS score (7.2 to 2.0). In conclusion, the association of arthroscopic implantation of autologous chondrocytes with a medial opening wedge osteotomy of the proximal tibia is a viable option for the management of chondral defects in varus knees. Crown Copyright © 2008 Published by Elsevier B.V. All rights reserved. Keywords: High tibial osteotomy; Arthroscopic autologous chondrocyte implantation; Varus knee; Chondral defects; Knee; Arthroscopy 1. Introduction If adequate correction is achieved by high tibial osteotomy (HTO) in a varus knee with a chondral defect, the hyaline cartilage lesion can be partially repaired by fibrocartilage [1,2]. Articular cartilage defects can be managed by marrow stimulation (i.e. subchondral drilling, abrasion arthroplasty, microfracture), auto- logous cultured chondrocyte implantation [3,4], osteochondral autograft transplantation [5] (i.e. mosaicplasty), or autogenous periosteal grafts [6]. Autologous chondrocyte implantation is a management option for chondral defects, but it is contraindicated in the presence of tibio-femoral malalignment, which would impose mechanical overload to the repair tissue [7,8]. For this reason, in patients with chondral defects plus a varus knee malalignment, we perform an opening wedge high tibial osteotomy and arthroscopic autologous chondrocyte implantation. We report the outcome of patients with chondral defects of the medial tibial plateau and varus malalignment of the knee who underwent arthroscopic implantation of autologous chondrocytes and a medial opening wedge high tibial osteotomy. 2. Patients and methods All procedures described in this investigation were approved by our Institutional Ethics Review Board. In the period January 2002 to December 2003, we performed arthroscopic implantations of autologous chondrocytes in conjunction with a medial opening wedge osteotomy in eight patients (four men and four women; mean age, 49.6 years, range: 42 to 58; Table 1) with chondral defects of the medial tibial plateau in idiopathic varus knee. The aetiology of the cartilage defect was unknown. All patients practised recreational sport. The exclusion criteria were age N 60 years, associated meniscal lesions and diffuse Available online at www.sciencedirect.com The Knee 15 (2008) 309 – 313 ⁎ Corresponding author. E-mail address: n.maffulli@keele.ac.uk (N. Maffulli). 0968-0160/$ - see front matter. Crown Copyright © 2008 Published by Elsevier B.V. All rights reserved. doi:10.1016/j.knee.2008.04.007