Opening Wedge High Tibial Osteotomy, Microfracture, and Bone Marrow Aspirate Concentrate for Treatment of Varus Deformity and Osteoarthritis of the Knee

Osteoarthritis in the setting of varus deformity can be difficult to treat in young and middle aged patients. Treatment options typically include arthroplasty versus joint preservation techniques. In young and middle aged patients, unicompartmental or total knee arthroplasty is often considered a less desirable treatment option due to the increased likelihood of requiring revision arthroplasty later in life. Joint preserving techniques, which combine a high tibial osteotomy to restore a neutral or even overcorrected mechanical axis with a cartilage resurfacing or transplantation procedure, are typically preferred. Recently, some researchers have advocated for biologic augmentation of cartilage resurfacing techniques using autologous stem cells. The purpose of this report is to present two patients with a varus mechanical axis deformity and extensive grade IV medial compartment osteoarthritis treated with a medial opening wedge high tibial osteotomy (HTO) and microfracture augmented with bone marrow aspirate concentrate (BMAC). Results of these two cases demonstrate restoration of a neutral mechanical axis, filling of the osteochondral defect observed on second look arthroscopy, and improvement in subjective outcome scores. While short-term results appear encouraging in this and other reports, long-term follow-up is needed to evaluate the efficacy of joint preserving techniques in patients with large osteochondral defects for delaying or preventing conversion to arthroplasty. Case Report Opening Wedge High Tibial Osteotomy, Microfracture, and Bone Marrow Aspirate Concentrate for Treatment of Varus Deformity and Osteoarthritis of the Knee Evan W. James*, Keith T. Corpus, Austin T. Fragomen, and S.