Editorial Commentary: Knee Cartilage Restoration Does Not Greatly Improve Clinical Outcomes After High Tibial Osteotomy-In the Short Term.

The treatment of osteoarthritis of the knee (OAK) is a complex matter with significant global, economic, and societal implications. Globally, OAK is currently estimated to affect more than 650 million individuals. In the United States alone, the cost of OAK treatments on the medical system was more than $140 billion in 2013. Because of the increased incidence of OAK as our population grows older, this topic is increasingly more pertinent to our research efforts to determine which treatments are most effective. Many of the treatments focus on cartilage restoration procedures looking to rebuild our knees back to their previous state. OAK is often accompanied with varus malalignment as a concomitant pathology necessitating high tibial osteotomy (HTO) to correct the deformity and provide a beneficial environment for the cartilage restoration to flourish. Cartilage restoration procedures include implanted chondrocytes, particulated juvenile cartilage, osteoarticular allografts, and novel modalities such as costal hyaline allograft. The addition of these restoration procedures is thought to enhance the results of HTO and provide longer duration of effects. Unfortunately, most studies have failed to show improved clinical outcomes in the short term, leading us to wonder whether longer term studies will show improved efficacy or are we just missing the bigger picture.