Summary

A high tibial osteotomy combined with medial meniscus posterior root repair for the treatment of medial meniscus posterior root tear increases the meniscus healing rate and cartilage generation but is not correlated with clinical outcome scores

Abstract

Introduction

There is still no consensus on whether a concurrent medial meniscus posterior root (MMPR) repair is beneficial in combination with a high tibial osteotomy (HTO) for the treatment of posterior medial meniscus root tear with varus deformity. The objective of this study was to evaluate the necessity of concurrent repair of PMMR during the primary HTO procedure. We hypothesized that concurrent MMPR repairs affect the healing rate of MMPR tear (MMPRT) and cartilage generation; therefore would be beneficial for clinical outcomes.

Materials And Methods

The medical record of patients who underwent HTO between 2014 to 2022 was studied retrospectively. Of 61 patients, 32 patients underwent HTO with either arthroscopically-assisted shaving arthroplasty or partial meniscectomy (Group A) and 29 underwent a concurrent MMPR repair using tibial bone tunnel pullout suture repair technique during HTO (Group B). The healing status of the MMPRT was categorized into healed, partially healed, and non-healed conditions. Outerbridge classification was used to evaluate cartilage regeneration. Clinical outcomes were evaluated according to the Lysholm score, IKDC, and KOOS.

Results

After a minimum follow-up of 24 months, all osteotomies had healed and the clinical outcomes showed no significant differences between the two groups (P<0.05). Twelve (37.5%) patients in group A and 15 (51.7%) patients in Group B underwent hardware removal and examination through arthroscopy at least one year following the primary surgery which showed Group B exhibited a higher healing rate (93.3% to 50.0%) and similar cartilage regeneration (31.3% to 41.7%). In consistency with previous studies, the integrity of MMPR played a minor role in cartilage regeneration. This leads to the interpretation that healing rate and cartilage regeneration are not correlated with clinical outcome scoring.

Discussion

An HTO could unload the pressure in the medial compartment, thus relieving varus-induced medial knee pain. According to previous studies, HTO alone without MMPR repair achieved favorable outcomes. Lee et al. and Ke et al. also described similar findings in their cohort studies. The beneficial effects of concurrent MMPR repair during HTOs increase the rate of meniscal healing. However, long-term follow-up should still be conducted in order to further investigate whether the repair technique could help provide longer survivorship of the HTOs.

Conclusions

Concurrent MMPR repair during HTOs presented with a better MMPR healing rate but similar cartilage regeneration rate in short-term to mid-term follow-up. However, a better healing rate was not associated with higher clinical scores. For deeper and more extensive conclusions to be drawn, follow-up should be continued long-term.