What to Add to Your HTOs, if Anything, in Patients With Severe Medial Compartment DJD

New graft material sounds appealing and appeared to make nice-looking cartilage, but patients did not seem to notice the difference

Smart Practice: Hyaline cartilage allograft was no better than subchondral drilling at the time of HTO — since drilling likely doesn’t do much (and in some patients causes pain), HTO alone may be the way to go.

What’s the Claim?

A matched-control study in patients who underwent medial opening wedge high tibial osteotomy found that a newer technique designed to restore cartilage, particulated costal hyaline cartilage allograft, when compared to subchondral drilling in patients with grade IV distal femoral cartilage lesions resulted in:

  • Better-looking and slightly thicker cartilage at the time of second-look arthroscopy two years later
  • But no advantage in any patient-reported outcomes scores at that time

How’s It Stack Up?