Management Considerations for Unicompartmental Osteoarthritis in Athletic Populations: A Review of the Literature

Abstract

Unicompartmental osteoarthritis in the young athlete poses a challenge for both patients and providers. Coronal plane malalignment is frequently a concomitant finding that adds to the complexity of management. Military surgeons are presented unique challenges, in that they must consider optimal joint-preservation methods while returning patients to a high-demand occupational function. Management options range from lifestyle changes to surgical interventions. We present a concise review of the available literature on this subject, with a specific focus on indications and outcomes within the military and young athletic population.

Keywords

orthopaedic surgery - knee osteoarthritis - osteotomies - military - cartilage

Publication History

Received: 31 October 2021

Accepted: 26 April 2022

Article published online:
07 July 2022

• References

• 1 Lawrence RC, Felson DT, Helmick CG. et al; National Arthritis Data Workgroup. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum 2008; 58 (01) 26-35
• 2 Sen R, Hurley JA. . Osteoarthritis. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2021 Jan. Available at: https://www.ncbi.nlm.nih.gov/books/NBK482326/
• 3 Cameron KL, Hsiao MS, Owens BD, Burks R, Svoboda SJ. Incidence of physician-diagnosed osteoarthritis among active duty United States military service members. Arthritis Rheum 2011; 63 (10) 2974-2982
• 4 Buckwalter JA, Mankin HJ. Articular cartilage. Part I: tissue design and chondrocyte-matrix interactions. J Bone Joint Surg Am 1997; 79: 600-611
• 5 Amoako AO, Pujalte GG. Osteoarthritis in young, active, and athletic individuals. Clin Med Insights Arthritis Musculoskelet Disord 2014; 7: 27-32
• 6 Mow V, Rosenwasser M. Articular cartilage: biomechanics. In: Woo SL-Y, Buckwalter JA. eds. Injury and Repair of the Musculoskeletal Soft Tissues. Park Ridge, IL: American Academy of Orthopedic Surgeons; 1988: 427-463
• 7 Flanigan DC, Harris JD, Trinh TQ, Siston RA, Brophy RH. Prevalence of chondral defects in athletes' knees: a systematic review. Med Sci Sports Exerc 2010; 42 (10) 1795-1801
• 8 Kane P, Frederick R, Tucker B. et al. Surgical restoration/repair of articular cartilage injuries in athletes. Phys Sportsmed 2013; 41 (02) 75-86
• 9 Lanyon P, O'Reilly S, Jones A, Doherty M. Radiographic assessment of symptomatic knee osteoarthritis in the community: definitions and normal joint space. Ann Rheum Dis 1998; 57 (10) 595-601
• 10 Wick MC, Kastlunger M, Weiss RJ. Clinical imaging assessments of knee osteoarthritis in the elderly: a mini-review. Gerontology 2014; 60 (05) 386-394
• 11 Cooke TD, Sled EA, Scudamore RA. Frontal plane knee alignment: a call for standardized measurement. J Rheumatol 2007; 34 (09) 1796-1801
• 12 Kraus VB, Vail TP, Worrell T, McDaniel G. A comparative assessment of alignment angle of the knee by radiographic and physical examination methods. Arthritis Rheum 2005; 52 (06) 1730-1735
• 13 Sheehy L, Cooke TDV. Radiographic assessment of leg alignment and grading of knee osteoarthritis: a critical review. World J Rheumatol 2015; 5 (02) 69-82
• 14 Bilodeau L, Murphy A. . Knee (Rosenberg view). Reference article, Radiopaedia.org. Accessed January 25, 2022 at: https://doi.org/10.53347/rID-57757
• 15 Rosenberg TD, Paulos LE, Parker RD, Coward DB, Scott SM. The forty-five-degree posteroanterior flexion weight-bearing radiograph of the knee. J Bone Joint Surg Am 1988; 70 (10) 1479-1483
• 16 Eckstein F, Gavazzeni A, Sittek H. et al. Determination of knee joint cartilage thickness using three-dimensional magnetic resonance chondro-crassometry (3D MR-CCM). Magn Reson Med 1996; 36 (02) 256-265
• 17 Raynauld JP, Martel-Pelletier J, Berthiaume MJ. et al. Quantitative magnetic resonance imaging evaluation of knee osteoarthritis progression over two years and correlation with clinical symptoms and radiologic changes. Arthritis Rheum 2004; 50 (02) 476-487
• 18 Slattery C, Kweon CY. Classifications in brief: Outerbridge classification of chondral lesions. Clin Orthop Relat Res 2018; 476 (10) 2101-2104
• 19 Aprato A, Sordo L, Costantino A. et al. Outcomes at 20 years after meniscectomy in young patients. Knee 2021; 29: 49-54
• 20 Bliddal H, Leeds AR, Christensen R. Osteoarthritis, obesity and weight loss: evidence, hypotheses and horizons—a scoping review. Obes Rev 2014; 15 (07) 578-586
• 21 Kolasinski SL, Neogi T, Hochberg MC. et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res (Hoboken) 2020; 72 (02) 149-162
• 22 Hinman RS, Hunt MA, Creaby MW, Wrigley TV, McManus FJ, Bennell KL. Hip muscle weakness in individuals with medial knee osteoarthritis. Arthritis Care Res (Hoboken) 2010; 62 (08) 1190-1193
• 23 Bhatia D, Bejarano T, Novo M. Current interventions in the management of knee osteoarthritis. J Pharm Bioallied Sci 2013; 5 (01) 30-38
• 24 Røgind H, Bibow-Nielsen B, Jensen B, Møller HC, Frimodt-Møller H, Bliddal H. The effects of a physical training program on patients with osteoarthritis of the knees. Arch Phys Med Rehabil 1998; 79 (11) 1421-1427
• 25 Carbone LD, Satterfield S, Liu C. et al; Health ABC Study. Assistive walking device use and knee osteoarthritis: results from the Health, Aging and Body Composition Study (Health ABC Study). Arch Phys Med Rehabil 2013; 94 (02) 332-339
• 26 Simic M, Bennell KL, Hunt MA, Wrigley TV, Hinman RS. Contralateral cane use and knee joint load in people with medial knee osteoarthritis: the effect of varying body weight support. Osteoarthritis Cartilage 2011; 19 (11) 1330-1337
• 27 Callaghan MJ, Parkes MJ, Felson DT. The effect of knee braces on quadriceps strength and inhibition in subjects with patellofemoral osteoarthritis. J Orthop Sports Phys Ther 2016; 46 (01) 19-25
• 28 Segal NA. Bracing and orthoses: a review of efficacy and mechanical effects for tibiofemoral osteoarthritis. PM R 2012; 4 (Suppl. 05) S89-S96
• 29 Siebers HL, Eschweiler J, Pinz J, Tingart M, Rath B. The effect of a knee brace in dynamic motion—an instrumented gait analysis. PLoS One 2020; 15 (09) e0238722
• 30 Dessinger GM, LaCour MT, Dennis DA, Kleeman-Forsthuber LT, Komistek RD. Can an OA knee brace effectively offload the medial condyle? An in vivo fluoroscopic study. J Arthroplasty 2021; 36 (04) 1455-1461
• 31 Arnold JB, Wong DX, Jones RK, Hill CL, Thewlis D. Lateral wedge insoles for reducing biomechanical risk factors for medial knee osteoarthritis progression: a systematic review and meta-analysis. Arthritis Care Res (Hoboken) 2016; 68 (07) 936-951
• 32 Steinmeyer J, Bock F, Stöve J, Jerosch J, Flechtenmacher J. Pharmacological treatment of knee osteoarthritis: special considerations of the new German guideline. Orthop Rev (Pavia) 2018; 10 (04) 7782
• 33 Nakata K, Hanai T, Take Y. et al. Disease-modifying effects of COX-2 selective inhibitors and non-selective NSAIDs in osteoarthritis: a systematic review. Osteoarthritis Cartilage 2018; 26 (10) 1263-1273
• 34 Zeng C, Wei J, Li H. et al. Effectiveness and safety of Glucosamine, chondroitin, the two in combination, or celecoxib in the treatment of osteoarthritis of the knee. Sci Rep 2015; 5: 16827
• 35 Fransen M, Agaliotis M, Nairn L. et al; LEGS study collaborative group. Glucosamine and chondroitin for knee osteoarthritis: a double-blind randomised placebo-controlled clinical trial evaluating single and combination regimens. Ann Rheum Dis 2015; 74 (05) 851-858
• 36 Billesberger LM, Fisher KM, Qadri YJ, Boortz-Marx RL. Procedural treatments for knee osteoarthritis: a review of current injectable therapies. Pain Res Manag 2020; 2020: 3873098
• 37 Jones IA, Togashi R, Wilson ML, Heckmann N, Vangsness Jr CT. Intra-articular treatment options for knee osteoarthritis. Nat Rev Rheumatol 2019; 15 (02) 77-90
• 38 Campbell KA, Erickson BJ, Saltzman BM. et al. Is local viscosupplementation injection clinically superior to other therapies in the treatment of osteoarthritis of the knee: a systematic review of overlapping meta-analyses. Arthroscopy 2015; 31 (10) 2036-45.e14
• 39 Rodriguez-Merchan EC. Intra-articular injections of hyaluronic acid and other drugs in the knee joint. HSS J 2013; 9 (02) 180-182
• 40 Cole BJ, Karas V, Hussey K, Pilz K, Fortier LA. Hyaluronic acid versus platelet-rich plasma: a prospective, double-blind randomized controlled trial comparing clinical outcomes and effects on intra-articular biology for the treatment of knee osteoarthritis. Am J Sports Med 2017; 45 (02) 339-346
• 41 Alabajos-Cea A, Herrero-Manley L, Suso-Martí L, Alonso-Pérez-Barquero J, Viosca-Herrero E. Are psychosocial factors determinant in the pain and social participation of patients with early knee osteoarthritis? A cross-sectional study. Int J Environ Res Public Health 2021; 18 (09) 4575
• 42 Wallis JA, Taylor NF, Bunzli S, Shields N. Experience of living with knee osteoarthritis: a systematic review of qualitative studies. BMJ Open 2019; 9 (09) e030060
• 43 Moseley JB, O'Malley K, Petersen NJ. et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 2002; 347 (02) 81-88
• 44 Kirkley A, Birmingham TB, Litchfield RB. et al. A randomized trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 2008; 359 (11) 1097-1107
• 45 Sofu H, Oner A, Camurcu Y, Gursu S, Ucpunar H, Sahin V. Predictors of the clinical outcome after arthroscopic partial meniscectomy for acute trauma-related symptomatic medial meniscal tear in patients more than 60 years of age. Arthroscopy 2016; 32 (06) 1125-1132
• 46 Herrlin S, Hållander M, Wange P, Weidenhielm L, Werner S. Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomised trial. Knee Surg Sports Traumatol Arthrosc 2007; 15 (04) 393-401
• 47 Katz JN, Brophy RH, Chaisson CE. et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med 2013; 368 (18) 1675-1684
• 48 Katz JN, Wright J, Spindler KP. et al. Predictors and outcomes of crossover to surgery from physical therapy for meniscal tear and osteoarthritis: a randomized trial comparing physical therapy and surgery. J Bone Joint Surg Am 2016; 98 (22) 1890-1896
• 49 Gu A, Malahias MA, Cohen JS. et al. Prior knee arthroscopy is associated with increased risk of revision after total knee arthroplasty. J Arthroplasty 2020; 35 (01) 100-104
• 50 Brinkman JM, Lobenhoffer P, Agneskirchner JD, Staubli AE, Wymenga AB, van Heerwaarden RJ. Osteotomies around the knee: patient selection, stability of fixation and bone healing in high tibial osteotomies. J Bone Joint Surg Br 2008; 90 (12) 1548-1557
• 51 Bonasia DE, Dettoni F, Sito G. et al. Medial opening wedge high tibial osteotomy for medial compartment overload/arthritis in the varus knee: prognostic factors. Am J Sports Med 2014; 42 (03) 690-698
• 52 Preston CF, Fulkerson EW, Meislin R, Di Cesare PE. Osteotomy about the knee: applications, techniques, and results. J Knee Surg 2005; 18 (04) 258-272
• 53 Brinkman JM, Luites JW, Wymenga AB, van Heerwaarden RJ. Early full weight bearing is safe in open-wedge high tibial osteotomy. Acta Orthop 2010; 81 (02) 193-198
• 54 Takeuchi R, Ishikawa H, Aratake M. et al. Medial opening wedge high tibial osteotomy with early full weight bearing. Arthroscopy 2009; 25 (01) 46-53
• 55 Ollivier B, Berger P, Depuydt C, Vandenneucker H. Good long-term survival and patient-reported outcomes after high tibial osteotomy for medial compartment osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2021; 29 (11) 3569-3584
• 56 Duivenvoorden T, Brouwer RW, Baan A. et al. Comparison of closing-wedge and opening-wedge high tibial osteotomy for medial compartment osteoarthritis of the knee: a randomized controlled trial with a six-year follow-up. J Bone Joint Surg Am 2014; 96 (17) 1425-1432
• 57 Ekhtiari S, Haldane CE, de Sa D, Simunovic N, Musahl V, Ayeni OR. Return to work and sport following high tibial osteotomy: A systematic review. J Bone Joint Surg Am 2016; 98 (18) 1568-1577
• 58 Liu JN, Agarwalla A, Christian DR. et al. Return to sport following high tibial osteotomy with concomitant osteochondral allograft transplantation. Am J Sports Med 2020; 48 (08) 1945-1952
• 59 Kunze KN, Beletsky A, Hannon CP. et al. Return to work and sport after proximal tibial osteotomy and the effects of opening versus closing wedge techniques on adverse outcomes: a systematic review and meta-analysis. Am J Sports Med 2020; 48 (09) 2295-2304
• 60 Waterman BR, Hoffmann JD, Laughlin MD. et al. Success of high tibial osteotomy in the United States Military. Orthop J Sports Med 2015; 3 (03) 2325967115574670
• 61 Kim YC, Yang JH, Kim HJ. et al. Distal femoral varus osteotomy for valgus arthritis of the knees: systematic review of open versus closed wedge osteotomy. Knee Surg Relat Res 2018; 30 (01) 3-16
• 62 Wylie JD, Hartley MK, Kapron AL, Aoki SK, Maak TG. Failures and reoperations after matrix-assisted cartilage repair of the knee: a systematic review. Arthroscopy 2016; 32 (02) 386-392
• 63 Shoji H, Insall J. High tibial osteotomy for osteoarthritis of the knee with valgus deformity. J Bone Joint Surg Am 1973; 55 (05) 963-973
• 64 Wang JW, Hsu CC. Distal femoral varus osteotomy for osteoarthritis of the knee. Surgical technique. J Bone Joint Surg Am 2006; 88 (suppl 1 Pt 1): 100-108
• 65 Backstein D, Morag G, Hanna S, Safir O, Gross A. Long-term follow-up of distal femoral varus osteotomy of the knee. J Arthroplasty 2007; 22 (04, Suppl 1): 2-6
• 66 van Lieshout WAM, van Ginneken BJT, Kerkhoffs GMMJ, van Heerwaarden RJ. Medial closing wedge high tibial osteotomy for valgus tibial deformities: good clinical results and survival with a mean 4.5 years of follow-up in 113 patients. Knee Surg Sports Traumatol Arthrosc 2020; 28 (09) 2798-2807
• 67 Rensing N, Prabhakar G, Kusnezov N, Zarkadis NJ, Waterman BR, Pallis M. Distal femoral osteotomy in a young symptomatic population: Outcomes correlate to concomitant pathology. J Orthop 2019; 16 (03) 283-288
• 68 Pal S, Draper CE, Fredericson M. et al. Patellar maltracking correlates with vastus medialis activation delay in patellofemoral pain patients. Am J Sports Med 2011; 39 (03) 590-598
• 69 Grawe B, Stein BE. Tibial tubercle osteotomy: indication and techniques. J Knee Surg 2015; 28 (04) 279-284
• 70 Beck PR, Thomas AL, Farr J, Lewis PB, Cole BJ. Trochlear contact pressures after anteromedialization of the tibial tubercle. Am J Sports Med 2005; 33 (11) 1710-1715
• 71 Liu JN, Wu HH, Garcia GH, Kalbian IL, Strickland SM, Shubin Stein BE. Return to sports after tibial tubercle osteotomy for patellofemoral pain and osteoarthritis. Arthroscopy 2018; 34 (04) 1022-1029
• 72 Gillogly SD, Arnold RM. Autologous chondrocyte implantation and anteromedialization for isolated patellar articular cartilage lesions: 5- to 11-year follow-up. Am J Sports Med 2014; 42 (04) 912-920
• 73 Fisher TF, Waterman BR, Orr JD, Holland CA, Bader J, Belmont Jr PJ. Tibial tubercle osteotomy for patellar chondral pathology in an active United States military population. Arthroscopy 2016; 32 (11) 2342-2349
• 74 Zarkadis NJ, Belmont Jr PJ, Zachilli MA. et al. Autologous chondrocyte implantation and tibial tubercle osteotomy for patellofemoral chondral defects: improved pain relief and occupational outcomes among US army servicemembers. Am J Sports Med 2018; 46 (13) 3198-3208
• 75 Zarrouk A, Bouzidi R, Karray B, Kammoun S, Mourali S, Kooli M. Distal femoral varus osteotomy outcome: Is associated femoropatellar osteoarthritis consequential?. Orthop Traumatol Surg Res 2010; 96 (06) 632-636