Medial Opening Wedge High Tibial Osteotomy Decreases Medial Meniscal Extrusion and Improves Clinical Outcomes and Return to Activity

Abstract

Background: Medial meniscal extrusion (MME) is defined as displacement of the meniscus that extends beyond the tibial margin. Knee varus malalignment increases MME. Purpose/Hypothesis: The purpose of this study was to quantify MME before and after medial opening wedge high tibial osteotomy (HTO) and to correlate the reduction of MME with clinical outcomes and return to activity. It was hypothesized that MME would decrease after HTO and that patients with lower MME after surgery would have improved clinical outcomes and return to activity at short-term follow-up. Study Design: Case series; Level of evidence, 4. Methods: This study included 66 patients who underwent HTO to correct the anatomic axis with a minimum follow-up of 2 years. MME was measured using magnetic resonance imaging preoperatively and 6 weeks after surgery (study protocol). Patients were assessed preoperatively and postoperatively with the Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS) score for pain, and Tegner score. Results: The mean ± SD preoperative and postoperative MME values were 3.9 ± 0.6 mm and 0.9 ± 0.5 mm, respectively. At 2 years after surgery, KOOS, pain VAS, and Tegner scores were higher than those found preoperatively ( P < .001). Patients with less than 1.5 mm of MME after surgery had better clinical outcomes and return to activity compared with patients who had MME of 1.5 mm or more ( P < .05). Conclusion: Medial opening wedge HTO decreased MME after 6 weeks and improved clinical outcomes and return to activity at a minimum 2-year follow-up. Additionally, patients with postoperative MME of less than 1.5 mm had better clinical outcomes and return to activity compared with patients who had postoperative MME of 1.5 mm or more.

The efficacy and safety of tranexamic acid in high tibial osteotomy: a systematic review and meta-analysis

“…High tibial osteotomy (HTO) is a widely used and well-established effective surgical treatment which aims to correct the varus malalignment or deformation with compartmental osteoarthritis or osteonecrosis of the knee in both young and elderly patients [ 1 ]. HTO is intended to shift the misaligned mechanical axis to the midline of the knee to restore normal limb alignment, thereby minimizing the load on the medial compartment to slow down the osteoarthritis progression [ 2 – 4 ].…”

Postoperative Bone Marrow Lesions (BMLs) are Associated with Pain Severity in Patients Undergoing Open Wedge High Tibial Osteotomy (OWHTO)

“…Promisingly, many studies have demonstrated that knee pain could be relieved by open wedge high tibial osteotomy (OWHTO) 9-12 . OWHTO is an effective procedure for patients with medial unicompartmental KOA [13][14][15][16] . In a study conducted by Astur et.al, 66 patients who underwent OWHTO were reviewed, The postoperative scores, including Knee Injury and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS), and Tegner scores were higher than those found preoperative 17 . In a study conducted by Altay et.al, 34 patients who underwent OWHTO were reviewed, VAS scores improved signi cantly from preoperative 53.71 ± 10.02 to postoperative 14.12 ± 6.08, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores improved signi cantly from preoperative 57.34 ± 6.37 to postoperative 31.94 ± 5.12 18 .…”

Preoperative planning by osteotomy master software helps to improve the accuracy of target limb alignment in high tibial osteotomy

“…However, patients cannot engage in strenuous exercise after TKA, and the prosthesis has a certain number of years of use. For young patients, the surgical effect is limited and the risk of surgical failure increases [ 2 , 3 ]. Thus, TKA is too aggressive and HTO is an ideal choice for younger patients who have a high demand for activity and are confined to medial compartment osteoarthritis of the knee combined with varus deformity [ 2 , 4 ].…”

“…HTO is generally suitable for patients younger than 60 years old, with limited medial compartment osteoarthritis, no obvious wear on the tibiofemoral and patellofemoral articular surfaces, tibial varus deformity between 5° and 20°, and high demand for postoperative activity [ 7 , 8 ]. It has been reported that some athletes can return to the arena after HTO [ 2 ].…”