Aims: To assess the outcome of biological resurfacing combined with osteotomy for knee osteoarthritis [OA] in young individuals.

Methods: Between January 2001 and March 2006, 25 active patients with unicompartmental OA were treated with a combination of cartilage resurfacing and tibial or femoral osteotomy. The cartilage resurfacing procedure was microfracture on both surfaces in 20 patients, Matrix Autologous Chondrocyte Implantation in 3, Autologous Chondrocyte Transplantation in 1 and Meniscal transplantation in 1. For limb realignment, an open wedge High Tibial Osteotomy was performed in 23 patients and Distal Femoral Osteotomy in 2 patients, using either the Puddu plate (Arthrex) or the Tomofix plate (Synthes).

There were 23 male and 2 female patients with a mean age of 45 years (range 27 to 60). The median follow-up period was 22.5 months (range 6 to 60). At follow-up patients were assessed radiographically and clinically using the knee society clinical score [KSS] and the Tegner activity scale.

Results: The outcome was satisfactory in 20 patients who had improvement in pain and function. The median Tegner activity level was 5.5 and the median KSS was 164. Poor results in five patients were due to delayed union in 1, nonunion in 2 and persistent severe pain in 2 who subsequently underwent unicompartmental or total knee replacement.

Discussion and conclusion: Management of the young active individual with grade 4 bare bone arthritis in the knee is challenging, and arthroplasty may not provide the ideal solution. Our series has shown that combining opening wedge osteotomy with cartilage repair results in improvement in a high proportion of patients. Such salvage surgery or ‘biological resurfacing’ may therefore have a place in the management of active young patients with bare bone osteoarthritis.