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High tibial osteotomy for medial meniscus posterior root tears in knees with moderate varus alignment can achieve favorable clinical outcomes.

ABSTRACT:

Purpose

Favorable clinical results have been reported following high tibial osteotomy (HTO) for medial meniscus posterior root tear (MMPRT) in knees with varus alignment. However, the effect on the preoperative neutral alignment of the knee is not known. This study sought to evaluate the clinical outcomes of medial open-wedge HTO for MMPRT with neutral alignment.

Methods

We retrospectively reviewed 119 medial open-wedge HTOs and analyzed 22 knees with MMPRT. The knees were divided according to the preoperative hip-knee-ankle angle into a moderate varus alignment group (≤4° of varus alignment) and a varus alignment group (> 4° of varus alignment). The Knee Injury and Osteoarthritis Outcome Score (KOOS) and Forgotten Joint Score-12 (FJS-12) values were evaluated preoperatively and at the latest follow-up. The healing status of MMPRT at the time of second-look arthroscopy, performed at a mean of 15.4 ± 4.2 months, was compared with that after the primary HTO.

Results

There were 11 knees in the moderate varus alignment group and 11 in the varus alignment group. In terms of perioperative patient-reported outcome measures, there was no significant difference in the preoperative or postoperative KOOS subscale score or FJS-12 score between the moderate varus and varus alignment groups. The healing rate was significantly higher in the moderate varus alignment group.

Conclusion

Favorable clinical results were obtained by medial open-wedge HTO in knees with MMPRT and moderate varus alignment in the short term. Surgeons should consider the indications for medial open-wedge HTO, even with moderate varus alignment, when planning treatment for MMPRT with persistent knee pain.

Level of evidence

IV.

SUBMITTER: Itou J

PROVIDER: S-EPMC9263016 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:PurposeTo analyze the change in rotational alignment caused by double level osteotomy (DLO) based on comparative three-dimensional image analysis of pre- and postoperative CT images.MethodsPre- and postoperative CT examination of the lower extremities were performed with informed consent for 39 consecutive knees undergoing DLO for varus knee deformity. The DLO procedure consisted of closed wedge distal femoral osteotomy (CWDFO) and open wedge high tibial osteotomy (OWHTO). Among those cases, 20 knees complicated with hinge fracture at the osteotomy site were excluded from the analysis to eliminate a confounding factor affecting the results. Consequently, data obtained from 19 knees were subjected to the study analysis while osteotomies with hinge fractures complications were excluded from the study. In the three-dimensional CT image analysis of axial plane images, femoral torsion (the angle between midline along the femoral neck axis and the tangent of the posterior edges of the medial/lateral femoral condyles) and tibial torsion (the angle between the tangent of the posterior edges of the medial/lateral tibial condyles and the transmalleolar axis) were measured. The torsion angle was measured in each of the femurs and the tibias on both pre- and postoperative CT axial images, and the change induced by the osteotomy was calculated and statistically(using Wilcoxon signed-rank test) compared.ResultsThe mean pre- and postoperative femoral torsion (anteversion) angles were 29.3° and 31.4° with a significant postoperative increase in internal rotation of the bony segment distal to the osteotomy(P = 0.002). On the tibial side, the mean pre- and postoperative torsion angles were 26.5° and 25.7°, indicating no significant postoperative change(P = 0.199)（NS）.ConclusionsThis study showed that the DLO procedure (combining CWDFO and OWHTO) increased torsion (anteversion) of the femur by 2.1° on average while inducing no significant rotational change on the tibial side.