Mylène Jansen

290 Chapter 14 bone area changes between groups changed when correcting for the trial in which patients were treated, indicates there are indeed parameters of importance that were not considered in this trial. These are likely to be structural parameters, since the influence of baseline clinical outcome on cartilage thickness change was found not to be significant (baseline VAS pain, EQ5D, ICOAP, WOMAC and KOOS, including all subscales, all p> 0.1). Future studies including more parameters, using for example qualitative MRI scans, could provide a better insight into which factors determine cartilage restoration response and with that might improve the patient selection process. In conclusion, for patients included in the same trial (KJD versus HTO), the 2 treatments showed similar results in MAC cartilage restoration. It was expected that HTO would show worse results in the LAC, but this was not the case. Based on subgroup analyses, it was shown that in patients with severe knee OA, KJDmay be more efficient in restoring cartilage thickness than HTO is. In patients with mild knee OA, neither HTO nor KJD treatment results in significant cartilage restoration over 2 years and both treatments show a slight deterioration that is likely the result of natural OA progression. There were no differences between the treatments for changes in the LAC. Based on these results, this research suggests that knee joint distraction as joint-preserving surgery could be a good option in case of knee OA patients with more severe structural damage. This should be confirmed in a larger trial specifically designed for this purpose.