The document summarizes a study on high tibial osteotomy with concomitant meniscal scaffold implantation. It discusses how osteotomies can transfer loading from arthritic to healthy cartilage areas. It also notes that meniscectomies increase contact stresses in the knee joint. The study involved 10 patients receiving collagen scaffolds, 10 receiving polyurethane scaffolds, and 20 control patients receiving osteotomy alone. Results found the osteotomies achieved good union and correction maintenance, and patients receiving meniscal repair showed superior clinical improvement compared to debridement alone, with no difference between scaffold types.

1. iBalance High Tibial Osteotomy with
Concomitant Meniscal Scaffold Implantation
Konrad Slynarski, Emilia Kurowska, Tadeusz Scinski
Sports Medicine Center CMS
Warsaw, Poland
8th Biennial ISAKOS Congress May 15-19, 2011 in Rio de Janeiro, Brazil

2. The main principle of osteotomies is to achieve a transfer of loading from diseased, arthritic areas
of the joint to areas with relatively intact, healthy cartilage.

3. varus alignment will
not predispose to OA
• Knee alignment does not predict
incident osteoarthritis: the
Framingham OA study Hunter DJ,
Arthiritis Reum 2007;56:1212-1218

4. meniscectomy of the knee
•Menisci transmit a minimum of 50% of the compressive load
in the tibiofemoral joint, and when the medial meniscus is
removed, the contact area may decrease as much as 50% to
70% causing 40% increase in contact stresses
•significantly increased risk of developing radiographic knee
OA in the total meniscectomy group when compared with the
partial meniscectomy.
•In stable knees of patients at mean age 29 causes joint space
narrowing (mean, 1.2 mm) at 12-year follow-up

5. is it enough to
restore the
alignment only?
anatomy?
function?
activity?

6. iBALANCE HTO

7. iBALANCE HTO

9. Collagen vs. Polyurethane scaffolds
10 patients 10 patients
p=0.141
collagen t-test
polyurethane
20 implant patients

10. 20 HTO case matched - control group

11. Tukey test (post hoc analysis)

12. Tukey test (post hoc analysis)

13. Tukey test (post hoc analysis)

14. Tukey test (post hoc analysis)

15. Tukey test (post hoc analysis)

16. conclusions
• The Ibalance osteotomy achieved perfect
rates of union and maintenance of
correction.
• Clinical improvement in patients treated
with concomitant medial meniscus repair
were superior to group treated with
osteotomy and debridement alone
• without statistical differences between
types meniscus implants used.

17. references
• Framingham OA study Hunter DJ, Arthiritis
Reum 2007;56:1212-1218
• Ahmed AM. J Biomech Eng. 1983;105:216-225.).
• K. Donald Shelbourne and Jonathan F. Dickens Am J
Sports Med 2006 34: 1648

18. Thank You