The Efficacy of High Tibial Osteotomy with or without Post-root Medial Meniscus Repair: A Systematic Review

Journal of Clinical Orthopaedics | Vol 8 | Issue 2 |  Jul-Dec 2023 | page: 80-84 | Aishwarya Roy, Kiran Kumari, Miten Sheth


Authors: Aishwarya Roy [1], Kiran Kumari [2], Miten Sheth [1]

[1] Third Year Junior Resident in Seth GS Medical College & KEM Hospital, Mumbai, India,

[2] Postgraduate student, Msc Public Health, University of Bristol, United Kingdom.

Address of Correspondence
Dr. Aishwarya Roy,
16/2 P. majumder Road Kolkata -700078, India.


Background: High tibial osteotomy (HTO) is a knee joint treatment modality for medial compartment arthritis, aiming to improve articular cartilage healing by shifting the lower limb’s axis. It is commonly used in younger patients with pain and active lifestyles, preventing advanced cartilage deterioration. Varus malalignment may often be accompanied with medial meniscus root tears. In recent years, meniscus root tears are often been repaired. However, the efficacy of medial meniscus repairs with high tibial in varus malalignment with medial meniscal tears remains a controversy.
Purpose: The purpose is to study the functional outcomes of concurrent medial meniscus root repair with HTO versus HTO alone.
Study design: Systematic review.
Methods: According to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, we searched PubMed, Embase, Web of Science, and the Cochrane Library databases for studies reporting the outcomes of medial meniscus posterior root tear (MMPRT) repair with HTO versus HTO alone and extracted data about characteristics of patients, clinical functional scores, and radiologic outcomes. One reviewer extracted data and 1 reviewer assessed the risk of bias and performed a synthesis of the evidence. Articles were eligible if they reported the functional outcome of HTO alone or HTO and MMPRT repair in patients of varus malalignment and medial meniscus root tears.
Results: 6 studies with 264 patients were identified. Data from these studies were segregated in HTO only and HTO with medial meniscus repair group. The findings of this systematic review suggest that the outcomes of HTO with MMPHRR and of only HTO are not statistically significant, meaning that doing valgus osteotomy only in patients with varus knee and MMPHRT can give good results regardless of not repairing the meniscus.
Conclusion: HTO with medial meniscus posterior horn root repair seems to have no significant improvement in the functional outcomes of the patient. However, long-term studies need to be performed.
Keywords: High tibial osteotomy, medial meniscus, root repair, arthroscopy, varus malalignment, meniscus, root tear


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How to Cite this article: Roy A, Kumari K. The Efficacy of High Tibial Osteotomy with or without Post-root Medial Meniscus Repair: A Systematic Review. Journal of Clinical Orthopaedics 2023;8(2):80-84.

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Invasive Non-Arthroplasty Treatment Options for Knee Osteoarthritis: Review

Journal of Clinical Orthopaedics | Vol 8 | Issue 1 |  Jan-Jun 2023 | page: 08-17 | Rohan G Reddy, YuChia Wang, Ryan Scully, Savyasachi C Thakkar

DOI: :10.13107/jcorth.2023.v08i01.549

Author: Rohan G Reddy [1], YuChia Wang [2], Ryan Scully [3], Savyasachi C Thakkar [4]

[1] Orthopaedic Research Collaborative (ORC); Johns Hopkins University, Baltimore, Maryland, United States, ,
[2] Orthopaedic Research Collaborative (ORC);Department of Orthopaedic Surgery, Eastern Virginia Medical School, Norfolk, Virginia, United States,
[3] Orthopaedic Research Collaborative (ORC); Department of Orthopaedic Surgery, Naval Hospital Camp Pendleton, Oceanside, California, United States,

[4] Orthopaedic Research Collaborative (ORC); Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, United States.

Address of Correspondence
Dr. Rohan G Reddy,

Johns Hopkins University, Baltimore, Maryland, United States.



Introduction: Knee osteoarthritis (KOA) is one of the most common joint diseases in the world, such that there exists a variety of treatment methods, ranging from conservative treatments such as physical therapy and weight loss to total replacement of the diseased joint. Invasive non-arthroplasty treatment methods are growing in popularity and this review aims to explore the current literature. Better understanding of these alternatives could allow orthopedic surgeons and primary care providers to offer poor arthroplasty candidates meaningful symptomatic relief.

Materials and Methods: A literature review using PubMed, Google Scholar, and SCOPUS was performed to examine the following invasive non-arthroplasty treatment options: Corticosteroid injections (CS), viscosupplementation, platelet-rich plasma injections, stem cell injections, ozone therapy, prolotherapy, radiofrequency nerve ablation (RFA), arthroscopy, and osteotomy. Articles with complete data on the outcomes following these treatment methods were included in the study.

Results: CSs showed strong efficacy in providing short-term pain relief, while viscosupplementation and platelet-rich plasma have shown to be effective in long-term management as well. Aside from the more common injectable treatment options, newer options such as stem cell injection and ozone therapy have shown clinical efficacy while prolotherapy and RFA are still early-stage treatment options. Still, further studies are required to better assess these emerging therapies. Operatively, arthroscopic surgery has shown to be minimally effective while osteotomy demonstrated effective pain and functional improvement.

Conclusion: Multiple therapeutic options exist for invasive management of KOA to a different degree of effectiveness and efficacy. We have analyzed the outcomes of multiple invasive non-arthroplasty treatment options for KOA. This review can better inform patients and surgeons of the pros and cons of different KOA treatment methods. Newer conservative options may have positive clinical implications but will require further investigation. Operative alternatives to arthroplasty can provide symptomatic relief but may increase the associated risk and complexity should the need for arthroplasty ever arises.

Keywords: Total knee arthroplasty, injections, radiofrequency nerve ablation, arthroscopy, osteotomy.


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How to Cite this article: Reddy RG, Wang Y, Scully R, Thakkar SC. Invasive Non-arthroplasty Treatment Options for Knee Osteoarthritis: Review. Journal of Clinical Orthopaedics Jan-Jun 2023;8(1):08-17.

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Unusual Finding of Gouty Tophus in Adult Male with Acute Locked Knee: A Rare Case Report

Journal of Clinical Orthopaedics | Vol 6 | Issue 2 |  Jul-Dec 2021 | page: 42-44 | Febyan, I Gusti Ngurah Paramartha Wijaya Putra, Made Deker, Agus Eka Wiradiputra

Author: Febyan [1], I Gusti Ngurah Paramartha Wijaya Putra [1], Made Deker [1], Agus Eka Wiradiputra [1]

[1] Department of Orthopaedics & Traumatology, Bhayangkara Denpasar Hospital, Bali, Indonesia

Address of Correspondence
Dr. Febyan,
Department of Orthopaedics & Traumatology, Bhayangkara Denpasar Hospital, Bali, Indonesia


Gout is an inflammatory disease commonly characterized by tophus deposits containing uric acid crystals in the intraarticular joints. An acute locked joint due to gouty tophus formation is a rare finding. This case describes a 36-year-old man with sudden pain and locking in the knee joint. Physical examination, plain radiography, and serum uric acid examination showed unremarkable results. Further investigation with diagnostic arthroscopy confirmed tophaceous gout as the sole cause of an acutely locked knee. The patient exhibited satisfactory clinical results following surgical intervention under arthroscopy and the administration of urate-lowering agents. This case highlights the probability of tophus deposition as the cause of an acute locked knee, despite unremarkable initial presentation. The awareness regarding this case should be raised, especially on emphasizing arthroscopy as a cost-effective diagnostic and therapeutic modality in patient management.

Keywords: Arthroscopy, gouty tophi, knee joint, rare case


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How to Cite this article: Febyan, Putra IGNPW, Deker M, Wiradiputra AE. Unusual Finding of Gouty Tophus in Adult Male with Acute Locked Knee: A Rare Case Report. Journal of Clinical Orthopaedics Jul-Dec 2021;6(2):42-44.

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Partial Rotator Cuff Tears: a review of the literature

Journal of Clinical Orthopaedics | Vol 5 | Issue 2 |  July-Dec 2020 | page:30-34 | Stefania Kokkineli, Emmanouil Brilakis, Emmanouil Antonogiannakis

Author: Stefania Kokkineli [1], Emmanouil Brilakis [1], Emmanouil Antonogiannakis [1]

[1] Department of Orthopaedic, HYGEIA Hospital. MD. Erythrou Stavrou 4, Marousi 15123

Address of Correspondence
Dr. Stefania Kokkineli,
Department of Orthopaedic, HYGEIA Hospital. Athens, Greece
Address: Erythrou Stavrou 4, Marousi 15123. Greece


Partial- thickness rotator cuff tears are the most common cause of shoulder pain in adults and have been classified into subtypes according to location and depth. The frequency rate and tear size progression increase with age, tobacco use and medical comorbidities. Partial tears are divided into tears of acute, chronic or acute-on-chronic onset. Surgical treatment is indicated in symptomatic patients with persistent pain after failed conservative treatment of at least 3 months, mainly with tears that exceed 50% of the tendon thickness. Arthroscopic repair techniques include in situ and tear completion repair. Authors’ preferred technique for in situ repair is described followed by the postoperative rehabilitation protocol. The surgical techniques described have various advantages and disadvantages with regard to intra- operative complications, clinical outcomes, recovery time and re-tear rates which make it difficult to decide on which technique to use. The option is a matter of surgical indications, philosophy and skills.
Keywords: Partial-thickness rotator cuff tears, transtendon repair, in-situ repair, shoulder, arthroscopy


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10. Kanatli, U., Ayanoğlu, T., Aktaş, E., Ataoğlu, M. B., Özer, M., Çetinkaya, M. Grade of coracoacromial ligament degeneration as a predictive factor for impingement syndrome and type of partial rotator cuff tear. JSES. 2016;25(11), 1824–1828. doi:10.1016/j.jse.2016.02.026.
11. Jordan, R., W., Bentick, K., Saithna, A. Transtendinous Repair of Partial Articular Sided Supraspinatus Tears is associated with Higher Rates of Stiffness and Significantly Inferior Early Functional Scores than Tear Completion and Repair: A Systematic Review. Orthop Traumatol Surg. 2018;104(6):829-837. doi:10.1016/j.otsr.2018.06.007.
12. Liem, D., Gosheger, G., Vogler, T. PASTA-Läsionen – Debridement versus Naht. Der Orthopäde. 2016;45(2):125–129. doi:10.1007/s00132-015-3201-1.
13. Kim HJ, Kim JY, Kee YM, Rhee YG. Bursal-Sided Rotator Cuff Tears: Simple Versus Everted Type. Am J Sports Med. 2017;46(2):441–448. doi:10.1177/0363546517739577.
14. Habermeyer, P., Krieter, C., Tang, K., Lichtenberg, S., Magosch, P. A new arthroscopic classification of articular-sided supraspinatus footprint lesions: A prospective comparison with Snyder’s and Ellman’s classification. JSES. 2008;17(6):909–913. doi:10.1016/j.jse.2008.06.007.
15. Rahu, M., Kartus, J., T., Põldoja, E., Pedak, K., Kolts, I., Kask, K. Do Articular-Sided Partial-Thickness Rotator Cuff Tears After a First-Time Traumatic Anterior Shoulder Dislocation in Young Athletes Influence the Outcome of Surgical Stabilization? Orthop J Sports Med. 2018;6(6):232596711878131. doi:10.1177/2325967118781311.
16. Dow, D. F., Mehta, K., Xu, Y., England, E. The Relationship Between Body Mass Index and Fatty Infiltration in the Shoulder Musculature. J Comput Assist Tomogr. 2018;42(2):323-329. doi:10.1097/rct.0000000000000672.
17. Yamamoto, N., Mineta, M., Kawakami, J., Sano, H., Itoi, E. Risk Factors for Tear Progression in Symptomatic Rotator Cuff Tears: A Prospective Study of 174 Shoulders. Am J Sports Med. 2017;45(11):2524–2531. doi:10.1177/0363546517709780.
18. Ranebo, M., C., Björnsson Hallgren, H., C., Adolfsson, L., E. Patients with a long-standing cuff tear in one shoulder have high rates of contralateral cuff tears: a study of patients with arthroscopically verified cuff tears 22 years ago. JSES. 2018;27(3):e68–e74. doi:10.1016/j.jse.2017.10.007.
19. Camurcu, Y., Ucpunar, H., Ari, H., Duman, S., Cobden, A., Sofu, H. Predictors of allocation to surgery in patients older than 50 years with partial-thickness rotator cuff tear. JSES. 2019;28(5):828-832. doi:10.1016/j.jse.2018.12.014.
20. Gereli, A., Kocaoglu, B., Ulku, T. K., Silay, S., Kilinc, E., Uslu, S., Nalbantoglu, U. Completion repair exhibits increased healing characteristics compared with in situ repair of partial thickness bursal rotator cuff tears. Knee Surg Sports Traumatol Arthrosc. 2018;26(8):2498–2504. doi:10.1007/s00167-018-4870-1.
21. Hahn, S., Lee, Y., H., Chun, Y., M., Park, E., H., Suh, J., S. Magnetic resonance arthrography results that indicate surgical treatment for partial articular-sided supraspinatus tendon avulsion: a retrospective study in a tertiary center. Acta Radiologica. 2017;58(9), 1115–1124. doi:10.1177/0284185116684673.
22. Hohmann, E., Shea, K., Scheiderer, B., Millett, P., Imhoff, A. Indications for Arthroscopic Subacromial Decompression. A Level V Evidence Clinical Guideline. Arthroscopy. 2019;36(3):913-922. doi:10.1016/j.arthro.2019.06.012
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24. Lacheta, L., Millett, P., J. Editorial Commentary: Is Arthroscopic In Situ Repair Effective for Long-Term Functional Recovery and Pain Relief in Symptomatic Partial Rotator Cuff Tears? Arthroscopy. 2019;35(3):703–705. doi:10.1016/j.arthro.2018.12.010.
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26. Ranalletta, M., Rossi, L., A., Bertona, A., B., Atala, N., A., Tanoira, I., Maignon, G., Bongiovanni, S., L. Arthroscopic Transtendon Repair of Partial-Thickness Articular-Side Rotator Cuff Tears. Arthroscopy. 2016;32(8):1523–1528. doi:10.1016/j.arthro.2016.01.027.
27. Rossi, L., A., Atala, N., A., Bertona, A., Bongiovanni, S., Tanoira, I., Maignon, G., Ranalletta, M. Long-Term Outcomes After In Situ Arthroscopic Repair of Partial Rotator Cuff Tears. Arthroscopy. 2019; 35(3):698-702. doi:10.1016/j.arthro.2018.09.026.
28. Shin SJ, Jeong JH, Jeon YS, Kim RG. Preservation of bursal-sided tendon in partial-thickness articular-sided rotator cuff tears: a novel arthroscopic transtendon anatomic repair technique. Arch Orthop Trauma Surg. 2016;136(12):1701–1708. doi:10.1007/s00402-016-2546-1.
29. Zafra M, Uceda P, Muñoz-Luna F, Muñoz-López RC, Font P. Arthroscopic repair of partial-thickness articular surface rotator cuff tears: single-row transtendon technique versus double-row suture bridge (transosseous equivalent) fixation: results from a prospective randomized study. Arch Orthop Trauma Surg. 2020;10.1007/s00402-020-03387-6.
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31. Osti, L., Buda, M., Andreotti, M., Osti, R., Massari, L., Maffulli, N. Transtendon repair in partial articular supraspinatus tendon tear. Br Med Bull. 2017;123(1):19–34. doi:10.1093/bmb/ldx023.
32. Heuberer, P., R., Smolen, D., Pauzenberger, L., Plachel, F., Salem, S., Laky, B., et al. Longitudinal Long-term Magnetic Resonance Imaging and Clinical Follow-up After Single-Row Arthroscopic Rotator Cuff Repair: Clinical Superiority of Structural Tendon Integrity. The Am J Sports Med.2017;45(6):1283–1288. doi:10.1177/0363546517689873..

How to Cite this article: Kokkineli S, Brilakis E, Antonogiannakis E. Partial Rotator Cuff Tears: a review of the literature. Journal of Clinical Orthopaedics July-Dec 2020;5(2):30-34.

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Posterior shoulder instability

Journal of Clinical Orthopaedics | Vol 5 | Issue 1 |  Jan-Jun 2020   | page: 31-35 | E. Taverna, A.Spreafico, C. Perfetti, V. Guarrella

Author: E. Taverna [1], A.Spreafico [1,2], C. Perfetti [1], V. Guarrella [1]

[1] IRCCS Istituto ortopedico Galeazzi, Milan, Italy
[2] Università degli studi di Milano, Scuola di specializzazione in Ortopedia e Traumatologia

Address of Correspondence
Dr. E. Taverna,
IRCCS Istituto ortopedico Galeazzi, Milan, Italy


Normally, shoulder movements are well balanced through an interplay between static structures (bone and soft tissues as capsule, ligaments and labrum) and muscular dynamic stabilizers (muscles and tendons). Dysfunction of one or more of these components due to an injury, degeneration or congenital abnormalities may lead to shoulder instability with concomitant pain and dysfunction. This article provides an overview of the soft tissue and bony anatomy of the shoulder joint and pathopysiology of shoulder instability. It also covers the important aspects of clinical examination and special test for diagnosis of shoulder instability. A brief over view of conservative and surgical management protocols for shoulder instability are also covered in view of recent literature and authors experience.
Keywords: Posterior shoulder instability, conservative treament, Surgical management, arthroscopy.


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How to Cite this article: Taverna E, Spreafico A, Perfetti C, Guarrella V. Posterior shoulder instability. Journal of Clinical Orthopaedics Jan-June 2020;5(1):31-35.

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