To compare the clinical efficacy of the patients with medial compartment knee osteoarthritis who underwent either opening-wedge high tibial osteotomy alone (HTO) or simultaneous HTO and pure platelet-rich plasma therapy (HTO+P-PRP).
Eighty patients were divided into 2 groups randomly, the HTO-alone group (n = 41) and the HTO+P-PRP group (n = 39). Patients were matched for preoperative age, sex, and body mass index. The outcomes studied included visual analogue scale (VAS) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Lysholm score. The minimum width of medial knee joint (MJSW), medial proximal tibial angle (MPTA), femoral tibial angle (FTA), and weightbearing line (WBL) were measured preoperatively, immediately postoperatively, and 1, 6, 12, and 24 months postoperatively. Paired t test and chi-squared test were used for statistical analysis.
All patients were followed up at 1, 6, 12, and 24 months postoperatively. At 1, 6, and 12 months, pain and function scores in the HTO+P-PRP group were better than those in the HTO-alone group, especially at 6 months in Lysholm score (HTO alone, 72.5 ± 10.6; HTO+P-PRP, 83.1 ± 14.7; P = .003, 95% CI –14.13 to –10.42) and WOMAC (HTO alone, 90.3 ± 11.9; HTO+P-PRP, 75.6 ± 15.4; P < .001, 95% CI 13.36 to 20.11). For both groups, no difference was found preoperatively (HTO alone, varus 3.5 ± 3.9; HTO+P-PRP, varus 4.1 ± 4.0; P = .898) or postoperatively (HTO alone, valgus 6.7 ± 4.5; HTO+P-PRP, valgus 7.7 ± 2.3; P = .768) in FTA or WBL. The increase of the MJSW in the HTO+P-PRP group was significantly greater than that in the HTO-alone group during the first year, especially at 6 months (HTO alone, 3.8 ± 1.2 mm; HTO+P-PRP, 4.6 ± 1.1 mm; P = .001, 95% CI –1.27 to –0.35).
Compared with HTO alone, HTO combined with intra-articular P-PRP improved the minimum medial knee joint space width during the first year postoperatively. Clinically, a higher proportion of patients in the HTO+P-PRP group exceeded the minimal clinically important difference (MCID) in the first year, especially at 6 months in Lysholm score (HTO alone, 65.9%; HTO+P-PRP, 97.4%) and WOMAC (HTO alone, 82.9%; HTO+P-PRP, 100.0%).
Level of Evidence
2, prospective comparative study.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Arthroscopy
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II.Arthritis Rheum. 2008; 58: 26-35
- Platelet-rich plasma and cartilage repair.Curr Rev Musculoskelet Med. 2018; 11: 573-582
- Osteoarthritis—A systematic review of long-term safety implications for osteoarthritis of the knee.BMC Musculoskelet Disord. 2019; 20: 151
- Corticosteroids and hyaluronic acid injections.Clin Sports Med. 2019; 38: 1-15
- Is local viscosupplementation injection clinically superior to other therapies in the treatment of osteoarthritis of the knee: A systematic review of overlapping meta-analyses.Arthroscopy. 2015; 31: 2036-2045.e14
- Chondral resurfacing and high tibial osteotomy in the varus knee: Survivorship analysis.Am J Sports Med. 2010; 38: 1420-1424
- Repair of articular cartilage and clinical outcomeafter osteotomy with microfracture or abrasion arthroplasty for medial gonarthrosis.Knee. 2007; 14: 465-471
- The influences of biomechanical factors on cartilage regeneration after high tibial osteotomy for knees with medial compartment osteoarthritis: Clinical and arthroscopic observations.Arthroscopy. 2002; 18: 725-729
- Remodeling of articular defects in an animal model.Clin Orthop Relat Res. 2004; : 59-63
- Platelet-rich plasma derived growth factors contribute to stem cell differentiation in musculoskeletal regeneration.Front Chem. 2017; 5: 89
- Human platelet-rich plasma induces chondrogenic differentiation of subchondral progenitor cells in polyglycolic acid-hyaluronan scaffolds.J Biomed Mater Res B Appl Biomater. 2014; 102: 681-692
- Autologous platelet-rich plasma promotes proliferation and chondrogenic differentiation of adiposederived stem cells.Mol Med Rep. 2015; 11: 1298-1303
- Activated platelet-rich plasma improves adipose-derived stem cell transplantation efficiency in injured articular cartilage.Stem Cell Res Ther. 2013; 4: 91
- Intra-articular platelet-rich plasma combined with hyaluronic acid injection for knee osteoarthritis is superior to P-PRP or HA alone in inhibiting inflammation and improving pain and function.Arthroscopy. 2021; 37: 903-915
- Platelet-rich plasma: Intra-articular knee injections produced favorable results on degenerative cartilage lesions.Knee Surg Sports Traumatol Arthrosc. 2010; 18: 472-479
- Standing radiographs cannot determine the correction in high tibial osteotomy.J Bone Joint Surg Br. 1991; 73: 927-931
- Open valgus alignment osteotomy of the proximal tibia with fixation by medial plate fixator [in German].Orthopade. 2004; 33: 153-160
- Gait analysis following medial opening-wedge high tibial osteotomy.Knee Surg Sports Traumatol Arthrosc. 2018; 26: 1838-1844
- Comparative outcomes of open-wedge high tibial osteotomy with platelet-rich plasma alone or in combination with mesenchymal stem cell treatment: A prospective study.Arthroscopy. 2014; 30: 1453-1460
- Research pearls: The significance of statistics and perils of pooling. Part 1: Clinical versus statistical significance.Arthroscopy. 2017; 33: 1102-1112
- Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen year follow up study.J Bone Joint Surg Am. 1987; 69: 332-354
- Comparison of clinical outcome following cartilage repair for patients with underlying varus deformity with or without additional high tibial osteotomy: A propensity score-matched study based on the German cartilage registry (KnorpelRegister DGOU).Cartilage. 2020; (1947603520982347)
- Role of high tibial osteotomy in cartilage regeneration—Is correction of malalignment mandatory for success?.Indian J Orthop. 2017; 51: 588-599
- Evaluation of cartilage regeneration by arthroscopy after high tibial osteotomy [in Chinese].Zhongguo Gu Shang. 2020; 33: 465-469
- High tibial osteotomy: Review of techniques and biomechanics.J Healthc Eng. 2019; 2019: 8363128
- Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range.BMC Med Res Methodol. 2014; 14: 135
- Measuring inconsistency in meta-analyses.BMJ. 2003; 327: 557-560
- Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement.PLoS Med. 2009; 6e1000097
- Role of low-grade inflammation in osteoarthritis.Curr Opin Rheumatol. 2017; 29: 79-85
- Interleukin-34 synovial fluid was associated with knee osteoarthritis severity: A cross-sectional study in knee osteoarthritis patients in different radiographic stages.Dis Marker. 2018; 2018: 2095480
- Rediscovering the therapeutic use of glucocorticoids in rheumatoid arthritis.Curr Opin Rheumatol. 2016; 28: 289-296
- Efficacy and safety of adalimumab by intra-articular injection for moderate to severe knee osteoarthritis: An open-label randomized controlled trial.J Int Med Res. 2018; 46: 326-334
- Isofraxidin inhibits interleukin-1β induced inflammatory response in human osteoarthritis chondrocytes.Int Immunopharmacol. 2018; 64: 238-245
- Comparison of intra-articular injections of plasma rich in growth factors (PRGF-Endoret) versus Durolane hyaluronic acid in the treatment of patients with symptomatic osteoarthritis: A randomized controlled trial.Arthroscopy. 2013; 29: 1635-1643
- Platelet-rich plasma shows beneficial effects for patients with knee osteoarthritis by suppressing inflammatory factors.Exp Ther Med. 2018; 15: 3096-3102
- Cocktail of hyaluronic acid and human amniotic mesenchymal cells effectively repairs cartilage injuries in sodium iodoacetate-induced osteoarthritis rats.Front Bioeng Biotechnol. 2020; 8: 87
- Better outcome from arthroscopic partial meniscectomy than skin incisions only? A sham controlled randomised trial in patients aged 35-55 years with knee pain and an MRI verified meniscal tear.BMJ Open. 2018; 8e019461
- Medial joint space width and convergence angle change with time after medial opening-wedge high tibial osteotomy.Knee. 2020; 27: 1923-1930
- Serial changes in the joint space width and joint line convergence angle after closed-wedge high tibialosteotomy.Am J Sports Med. 2017; 45: 3254-3261
Published online: September 24, 2021
Accepted: September 7, 2021
Received: April 28, 2021See commentary on page 486
The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Q. Zhang and W. Xu contributed equally to this article.
© 2021 by the Arthroscopy Association of North America