title: Biological knee reconstruction for combined malalignment, meniscal deficiency, and articular cartilage disease.
abstract: OBJECTIVE
  The aim of this study was to analyze patient-reported outcomes in those undergoing the triad of simultaneous osteotomy, meniscal transplantation, and articular cartilage repair.
  
  
  METHODS
  Patients undergoing simultaneous meniscal transplantation, distal femoral or proximal tibial osteotomy, and articular cartilage surgery by a single surgeon (B.J.C.) were analyzed. Meniscal transplantation was performed using bone-in-slot techniques. Distal femoral and high tibial osteotomies were performed for valgus and varus malalignment, respectively. Microfracture, autologous chondrocyte implantation, and osteochondral autograft or allograft were performed for articular cartilage disease. Validated patient-reported and surgeon-measured outcomes were collected. Preoperative and postoperative outcomes and medial versus lateral disease were compared using Student t tests.
  
  
  RESULTS
  Eighteen participants (mean age, 34 ± 7.8 years; symptomatic patients, 7.4 ± 5.6 years; 2.4 ± 1.0 surgical procedures before study enrollment; mean follow-up, 6.5 ± 3.2 years) were analyzed. Two thirds of participants had medial compartment pathologic conditions and one third had lateral compartment pathologic processes. At final follow-up, there were statistically significant clinically meaningful improvements in International Knee Documentation Committee (IKDC) subjective classification, Lysholm score, and 4 Knee Injury and Osteoarthritis Outcome Score (KOOS) subscores. Postoperative 12-item short form (SF-12) physical and mental component scores were not significantly different from preoperative scores. The Kellgren-Lawrence classification grade was 1.5 ± 1.1 at 2.5 ± 3.0 years after surgery. There was a significantly higher preoperative SF-12 physical composite score (PCS) in participants with lateral compartment pathologic conditions (v medial compartment conditions) (P = .011). Although there were 13 reoperations in 10 patients (55.5% reoperation rate), only one patient was converted to knee arthroplasty (5.6%) and one to revision cartilage surgery and meniscal transplantation (5.6% revision rate). The most common complication was arthrofibrosis (16.7%).
  
  
  CONCLUSIONS
  Statistically significant and clinically meaningful improvements in validated patient-reported clinical outcome scores at long-term follow-up were observed in 18 participants undergoing combined meniscal transplantation, osteotomy, and articular cartilage surgery. Although there was a low rate of cartilage or meniscal revision (or both) and total knee arthroplasty, there was a high rate of reoperation. There was no significant difference in outcomes between participants with medial versus lateral pathologic conditions.
  
  
  METHODS
  Level IV, therapeutic case series.
authors.affiliation: Houston Methodist Orthopaedics and Sports Medicine, Houston, Texas, U.S.A.; Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Harris
authors.affiliation: Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A.
authors.forename: Kristen
authors.initials: K
authors.lastname: Hussey
authors.affiliation: Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A.
authors.forename: Hillary
authors.initials: H
authors.lastname: Wilson
authors.affiliation: Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A.
authors.forename: Kyle
authors.initials: K
authors.lastname: Pilz
authors.affiliation: Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A.
authors.forename: Anil K
authors.initials: AK
authors.lastname: Gupta
authors.affiliation: Brigham and Women's Hospital and Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Andreas
authors.initials: A
authors.lastname: Gomoll
authors.affiliation: Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A.. Electronic address: brian.cole@rushortho.com.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Cole
mesh_terms: D000328:Adult; D017760:Bone Malalignment / Q000601:surgery*; D002357:Cartilage Diseases / Q000601:surgery; D002358:Cartilage, Articular / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D008592:Menisci, Tibial / Q000601:surgery* / Q000637:transplantation; D020370:Osteoarthritis, Knee / Q000601:surgery*; D010027:Osteotomy; D063868:Patient Outcome Assessment; D057566:Self Report; D016896:Treatment Outcome