Posts

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

DOI: https://doi.org/10.13107/jcorth.2023.v08i02.610


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.
E-mail: ash46roy@gmail.com


Abstract

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


References

1. Ke, Xiurong et al. “Concurrent arthroscopic meniscal repair during open-wedge high tibial osteotomy is not clinically beneficial for medial meniscus posterior root tears.” Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA vol. 29,3 (2021): 955-965. doi:10.1007/s00167-020-06055-9
2. Lee, Dhong Won et al. “Outcomes of Medial Meniscal Posterior Root Repair During Proximal Tibial Osteotomy: Is Root Repair Beneficial?.” Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association vol. 36,9 (2020): 2466-2475. doi:10.1016/j.arthro.2020.04.038
3. Jing, Lizhong et al. “Second-look arthroscopic findings after medial open-wedge high tibial osteotomy combined with all-inside repair of medial meniscus posterior root tears.” Journal of orthopaedic surgery (Hong Kong) vol. 28,1 (2020): 2309499019888836. doi:10.1177/2309499019888836
4. Suh, Dong Won et al. “Simple Medial Meniscus Posterior Horn Root Repair Using an All-Inside Meniscal Repair Device Combined with High Tibial Osteotomy to Maintain Joint-Space Width in a Patient with a Repairable Tear.” Indian journal of orthopaedics vol. 55,2 397-404. 31 Aug. 2020, doi:10.1007/s43465-020-00234-z
5. Kim YM, Joo YB, Lee WY, Kim YK. Remodified Mason-Allen suture technique concomitant with high tibial osteotomy for medial meniscus posterior root tears improved the healing of the repaired root and suppressed osteoarthritis progression. Knee Surg Sports Traumatol Arthrosc 2020;29:1258-68.
6. Omae, Hiroaki et al. “Arthroscopic pullout repair versus suture anchor repair for medial meniscus posterior root tear combined with high tibial osteotomy.” The Knee vol. 45 (2023): 117-127. doi:10.1016/j.knee.2023.10.011
7. Lee OS, Lee SH, Lee YS. Comparison of the radiologic, arthroscopic, and clinical outcomes between repaired versus unrepaired medial meniscus posterior horn root tear during open wedge high tibial osteotomy. J Knee Surg 2019;34:57-66.
8. Jing L, Liu K, Wang X, Wang X, Li Z, Zhang X, et al. Second-look arthroscopic findings after medial open-wedge high tibial osteotomy combined with all-inside repair of medial meniscus posterior root tears. J Orthop Surg (Hong Kong) 2019;28:230949901988883.
9. Ke X, Qiu J, Chen S, Sun X, Wu F, Yang G, et al. Concurrent arthroscopic meniscal repair during open-wedge high tibial osteotomy is not clinically beneficial for medial meniscus posterior root tears. Knee Surg Sports Traumatol Arthrosc 2020;29:955-645.
10. Kim KI, Bae JK, Jeon SW Kim GB. Medial meniscus posterior root tear does not affect the outcome of medial open-wedge high tibial osteotomy. J Arthroplasty 2021;36:423-8.
11. Omae H, Yanagisawa S, Hagiwara K, Ogoshi A, Omodaka T, Kimura M. Arthroscopic pullout repair versus suture anchor repair for medial meniscus posterior root tear combined with high tibial osteotomy. Knee 2023;45:117-27.
12. Lee HI, Park D, Cho J. Clinical and radiological results with second-look arthroscopic findings after open wedge high tibial osteotomy without arthroscopic procedures for medial meniscal root tears. Knee Surg Relat Res 2018;30:34-41.
13. Suh DW, Yeo WJ, Han SB, So SY, Kyung BS. Simple medial meniscus posterior horn root repair using an all-inside meniscal repair device combined with high tibial osteotomy to maintain joint-space width in a patient with a repairable tear. Indian J Orthop 2020;55:397-404.
14. Bin SI, Kim JM, Shin SJ. Radial tears of the posterior horn of the medial meniscus. Arthroscopy 2004;20:373-8.
15. Lee OS, Ahn S, Lee YS. Effect and safety of early weight-bearing on the outcome after open-wedge high tibial osteotomy: A systematic review and meta-analysis. Arch Orthop Trauma Surg 2017;137:903-11.

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.

(Abstract Text HTML)  (Download PDF)