Description
Objectives:Whether meniscus repair should be performed in addition to open wedge high tibial osteotomy (OWHTO) for medial meniscus posterior root tear (MMPRT) with varus alignment is still controversial, probably because existing surgical procedures for MMPRT repair could not sufficiently restore meniscus functions. Recently, meniscus centralization has been developed as a novel procedure to efficiently reduce meniscus extrusion. This study aimed to evaluate the effectiveness of additional meniscus centralization combined with pull-out repair and OWHTO for MMPRT with varus alignment.
Methods:We retrospectively analyzed 48 patients who underwent OWHTO with medial meniscus centralization and transtibial pull-out repair for MMPRT with varus alignment between 2017 2022. Of these, 37 patients with sufficient data and minimum 2-year follow up were included in the final analysis. Clinical outcomes including knee range of motion, Lysholm score, International Knee Documentation Committee (IKDC) subjective score, Knee Osteoarthritis Outcome Score (KOOS), and subjective patient satisfaction, and radiographic outcomes including joint space width in the Rosenberg view were evaluated. Furthermore, cartilage status of the medial femoral condyle (MFC) and medial tibial plateau (MTP) were evaluated at the initial surgery and second-look at the time of plate removal (one year after surgery) according to the International Cartilage Repair Society (ICRS) score. Healing status of the posterior root was also evaluated at second-look according to the following classification; complete healing, partial healing, scar tissue healing, and failed healing. Complete healing was defined as the absence of lifting on probing at 60 degrees of flexion, good meniscal continuity, and a smooth repaired site. Statistical analyses were performed using the Stata. Either paired t-test or the Wilcoxon signed-rank test was used for comparison.
Results:Both clinical and radiological outcomes at 2-year follow-up demonstrated an significant improvement compared to the preoperative status . While there was no significant difference in extension angles, range of motion in flexion improved. All clinical scores were significantly improved. Joint space width increased from 2.7 1± 0.96 mm before surgery to 2.85 ± 1.00 mm 2 years after surgery (p < 0.05). Complete meniscal healing was observed in 78% of patients. ICRS score was significantly improved at both MFC and MTP.
Conclusion:Additional meniscus centralization combined with pull-out repair and OWHTO significantly improved both clinical, radiological, and arthroscopic outcomes at short-term follow up. Further studies are required to investigate the significance of MMPRT repair and centralization combined with OWHTO.
