Concurrent Arthroscopic Meniscus Centralization With All-Inside Root Repair During Open-Wedge High Tibial Osteotomy Fails to Enhance Clinical Outcomes in Medial Meniscus Posterior Root Tear.

Abstract

To investigate whether concurrent arthroscopic meniscus centralization with all-inside side-to-side root repair during open-wedge high tibial osteotomy (OWHTO) provides superior clinical, radiological, and second-look arthroscopic outcomes compared with isolated OWHTO in patients with medial meniscus posterior root tears (MMPRTs). Between January 2020 and December 2021, 82 patients with symptomatic medial meniscus posterior root tears meeting prespecified criteria were prospectively enrolled and randomized into two groups: isolated OWHTO (Group A, n = 44) or OWHTO combined with arthroscopic meniscus centralization and all-inside side-to-side root repair (Group B, n = 38). Inclusion criteria included age 50-75 years, mild-to-moderate varus alignment, medial meniscus extrusion (MME) > 3 mm, flexion contracture < 10°, and intact lateral meniscus and cartilage. Demographic characteristics and second-look arthroscopic findings were compared between groups. Clinical outcomes (including range of motion and change in knee flexion [Δflexion]) and radiographic parameters-such as hip-knee-ankle angle, medial proximal tibial angle, and MME-underwent analysis for both intragroup pre- to postoperative changes and intergroup comparisons at preoperative and postoperative timepoints. Furthermore, the minimal clinically important difference (MCID) values were calculated for Lysholm scores and Δflexion. At a mean follow-up of 32.9 months (range, 26-41 months), with comparable duration between groups (P = .153), no significant differences were found between the two groups in terms of final Lysholm (P = .102) or Hospital for Special Surgery scores (P = .547). Δflexion was significantly greater in Group A than in Group B (P = .036). However, Group B exhibited significantly higher postoperative knee flexion loss than Group A (36.8% vs 13.6%; P < .001). This loss was more pronounced in Group B patients with preoperative flexion >130°, with the incidence of 66.7%. Regarding clinically relevant values, the cohort-specific MCID was calculated as 4.0 points for Lysholm score and 2.5° for Δflexion. All patients (100%) met the MCID threshold for Lysholm score, while 58.5% (48/82) achieved it for Δflexion. Notably, Group B had a higher proportion of patients failing to reach Δflexion MCID compared with Group A (44.7% vs 38.6%). Group B showed significantly decreased MME at final follow-up compared with Group A (0.8 mm vs 4.2 mm, P < .001) but no differences in other radiologic variables (including hip-knee-ankle angle and medial proximal tibial angle). Second-look arthroscopy revealed a significantly higher meniscal healing rate in Group B (28.9% vs 13.6%, P < .001). Nevertheless, no significant differences in postoperative Lysholm or Hospital for Special Surgery scores were observed between healed and nonhealed patients. Compared with isolated OWHTO, concurrent meniscus centralization with all-inside root repair resulted in reduced MME and improved meniscal healing, but did not confer superior clinical outcomes and was associated with a greater loss of knee flexion, particularly in patients with preoperative hyperflexion. Level II, lesser-quality randomized controlled trial.