The Effect of Bone Marrow Aspirate Concentrate on Clinical Results Used with Open Wedge High Tibial Osteotomy

Abstract

Objectives:

Medial open wedge high tibial osteotomy is a widely used treatment method for early stages of medial compartment osteoarthritis, particularly in the middle aged patients. Correction of the malalignment of the knee and even distribution of the body weight through knee joint is considered to facilitate the regeneration of the damaged cartilage. Addition of a regenerative procedure to tibial osteotomies may enhance its potential effects. In this study we analyzed the effect of, if any, simultaneous use of BMAC with high tibial osteotomy.

Methods:

We have evaluated the clinical results of 46 knees of 38 patients that underwent open wedge high tibial osteotomy for early stage medial compartment arthrosis between 2017-2020. Patients were recruited into two groups as HTO only group (Group 1) and HTO+BMAC group (Group 2). Mean follow up time was 12.6 months. Preoperative International Knee Documentation Committee (IKDC) subjective score and Knee Society Score (KSS) of the patients were compared with those at the 1^st, 3^rd, 6^th and 12^th post-operative months. Wilcoxon Ranked Signed test was used to detect the significant difference.

Results:

Group 1 consisted of 18 female and 4 male patients, Group 2 consisted of 14 female and 2 male patients. Two patients in Group 1 received bilateral HTO and 6 patients in Group 2 received bilateral HTO+BMAC. Twenty four knees in Group 1 and 22 knees in Group 2 were included for evaluation. There was no significant improvement in the KSS and IKDC scores of the patients in Group 1 at the first follow-up, however at the 3^rd month follow-up, KSS scores showed significant improvement (p<0,001) whereas IKDC scores did not show any improvement (p>0,005). Both KSS and IKDC scores showed significant improvement at the 6^th and 12^th months. (p<0,001). In Group 2, only KSS scores showed improvement at the 1^st month follow-up (p<0,001). Both KSS and IKDC scores showed significant improvement at the 3rd, 6^th and 12^th month follow-up compared to preoperative scores.

Conclusion:

We believe that simultaneous use of BMAC with open wedge high tibial osteotomy for early stage medial compartment arthrosis may relieve pain at the early period and improve patient compliance to rehabilitation. Increase in range of motion promote the recovery period and provide rapid return to daily activities, thereby positively affecting cartilage regeneration.