Repair of medial meniscus posterior root tear is effective for root healing and cartilage regeneration in opening wedge high tibial osteotomy

Abstract

Purpose This study aimed to determine whether the repair of a medial meniscus posterior root tear (MMPRT) is effective for MMPRT healing, cartilage regeneration, and clinical outcomes in opening wedge high tibial osteotomy (OWHTO). Methods This retrospective study included 80 patients who underwent OWHTO and subsequent second-look arthroscopy. The patients were divided into OWHTO-with-MMPRT-repair (n = 40) and OWHTO alone (n = 40) groups, and the healing rates (complete/partial/failure) were compared. Each group was further divided into over-and under-corrected subgroups to compare healing rates. The International Cartilage Repair Society (ICRS) grade, cartilage defect size, Koshino stage, ICRS cartilage repair assessment score of the medial femoral condyle (MFC), and International Knee Documentation Committee (IKDC) scores between the OWHTO-with-MMPRT-repair and OWHTO alone groups were compared according to whether microfracture was performed on the MFC. ResultsThe overall healing rate of the MMPRT was higher in the OWHTO-with-MMPRT-repair group than that in the OWHTO alone group (P < 0.001). In addition, in the subgroup analysis, no difference in the MMPRT healing rate between the over-correction and under-correction groups when MMPRT repair was performed (n.s). In contrast, without MMPRT repair, the healing rate was lower in the under-correction group than that in the over-correction group (P = 0.03). Cartilage regeneration of the OWHTO-with-MMPRT-repair group was superior to that of the OWHTO alone group (P < 0.05). The IKDC subjective scores of the OWHTO-with-MMPRT-repair and OWHTO alone groups were 34.5 and 33.1 before surgery (n.s) and 50 and 47.2 at one year after surgery, respectively (n.s). These differences between the two groups for cartilage regeneration and IKDC subjective scores showed the same pattern regardless of microfractures. Conclusions MMPRT repair during OWHTO might improve MMPRT healing, even with under-correction, and cartilage regeneration of MFC, regardless of microfracture. However, OWHTO with MMPRT repair might not improve short-term clinical outcomes compared to OWHTO alone. Further randomized clinical trials are necessary. Level of evidence III, Retrospective cohort study.

Better clinical outcomes and return to sport rates with additional medial meniscus root tear repair in high tibial osteotomy for medial compartmental knee osteoarthritis

“…Ke et al [20] reported that concurrent arthroscopic meniscal repair during OWH-TO did not lead to significant clinical benefits, even though an increased rate of meniscal healing was observed. Lee et al [29] and Choi et al [4] reported additional MMPRT repair in OWHTO meniscal healing rates but not clinical outcomes when compared with OWHTO alone. However, clinical studies conducted thus far are limited by the subjects being older than 55 years and some even being older than 65 years, making it difficult to determine definite conclusions about meniscal repair in OWHTO [4,18,27,28].…”

“…Lee et al [29] and Choi et al [4] reported additional MMPRT repair in OWHTO meniscal healing rates but not clinical outcomes when compared with OWHTO alone. However, clinical studies conducted thus far are limited by the subjects being older than 55 years and some even being older than 65 years, making it difficult to determine definite conclusions about meniscal repair in OWHTO [4,18,27,28]. Our study included young patients (50 years old or younger) who underwent OWHTO and MMPRT repair and demonstrated that additional MMPRT repair in young patients who underwent OWHTO improved clinical outcomes (HSS scores, Tegner scores and Lysholm scores).…”

“…The Lysholm score (86.7 ± 7.4 vs. 81.6 ± 6.9, p = 0.023), HHS score (85.4 ± 8.2 vs. 80.5 ± 7.1, p = 0.039) and Tegner score (6 [2-8] vs. 5 [2][3][4][5][6][7][8], p = 0.020) were greater in the OWHTO + Repair group than in the OWHTO group. Neither flexion contracture nor the range of knee flexion significantly differed between the two groups after surgery (Table 3).…”

Arthroscopic Transtibial Pullout Repair and Tibial Condylar Valgus Osteotomy for Medial Meniscus Posterior Root Tear With Varus Knee

“…Some scholars have proposed the MMPRT combined with HTO procedure. 17 , 18 , 19 , 20 In the study of Huang et al., 21 25 cases of MMPRT with varus knee were treated with ATPR combined with HTO. The average follow-up was 13.0 months.…”