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The methodological quality of the included studies was assessed with the Coleman Methodology Score (CMS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Out of the 7650 records identified from the databases, 42 articles were included for a total of 3580 patients and 3609\u00a0knees treated; 33 articles focused on surgical treatments and 9 on injective treatments performed in association with knee osteotomy. Out of the 17 comparative studies with surgical augmentation, only 1 showed a significant clinical benefit of an augmentation procedure with a regenerative approach. Overall, other studies showed no differences with reparative techniques and even detrimental outcomes with microfractures. Regarding injective procedures, viscosupplementation showed no improvement, while the use of platelet\u2010rich plasma or cell\u2010based products derived from both bone marrow and adipose tissue showed overall positive tissue changes which translated into a clinical benefit. The mean modified CMS score was 60.0\u2009\u00b1\u200912.1.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>There is no evidence to support the effectiveness of cartilage surgical treatments combined with osteotomies in terms of pain relief and functional recovery of patients affected by OA in misaligned joints. Orthobiologic injective treatments targeting the whole joint environment showed promising findings. However, overall the available literature presents a limited quality with only few heterogeneous studies investigating each treatment option. This ORBIT systematic analysis will help surgeons to choose their therapeutic strategy according to the available evidence, and to plan further and better studies to optimize biologic intra\u2010articular osteotomy augmentation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>Level IV.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-023-07469-x","type":"journal-article","created":{"date-parts":[[2023,6,18]],"date-time":"2023-06-18T10:01:32Z","timestamp":1687082492000},"page":"4327-4346","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Biological intra\u2010articular augmentation for osteotomy in knee osteoarthritis: strategies and results"],"prefix":"10.1002","volume":"31","author":[{"given":"Davide","family":"Reale","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Ortopedia e Traumatologia IRCCS Istituto Ortopedico Rizzoli Bologna 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