Concomitant arthroscopy during valgus-producing high tibial osteotomy does not demonstrate consistent additional clinical benefit despite improved cartilage findings: A systematic review of comparative studies.

Abstract

To evaluate whether concomitant arthroscopic treatment of intra-articular chondral or meniscal pathology during valgus-producing high tibial osteotomy (HTO) improves clinical outcomes compared with HTO alone. MEDLINE, Embase and CENTRAL were searched from inception to 17 May 2026. Comparative studies reporting outcomes after HTO plus arthroscopic cartilage (microfracture, microdrilling, abrasion arthroplasty) and/or meniscal (meniscal centralization, meniscectomy, meniscal repair) procedures versus HTO alone were included. Data extraction and quality assessment were performed by two reviewers. Due to heterogeneity, meta-analysis was not performed, and outcomes were synthesized descriptively, stratified by specific arthroscopic adjunct. Seventeen studies comprising 1271 knees were included, with 663 treated with HTO plus arthroscopy and 608 treated with HTO alone. The mean age was 57.0 years with HTO plus arthroscopy and 55.1 years with HTO. Mean follow-up was 32.9 months and 31.0 months, respectively. Concomitant procedures were microfracture in six studies, microdrilling in three, abrasion arthroplasty in two, meniscectomy in two, meniscal centralization in two and mixed arthroscopy in four. Both groups generally improved across patient-reported outcome measures (PROMs), functional outcomes and radiographic alignment. However, no arthroscopic adjunct demonstrated consistent additive clinical benefit. Microfracture showed inconsistent effects on Lysholm and Western Ontario and McMaster Universities Osteoarthritis Index scores; meniscectomy did not improve Knee Society Score; and meniscal centralization showed inconsistent Knee injury and Osteoarthritis Outcome Score and alignment findings. Mixed arthroscopy showed some favourable PROMs and radiographic outcomes, but did not isolate procedure-specific effects. Microfracture, microdrilling, abrasion arthroplasty and meniscal centralization improved cartilage findings on second-look arthroscopy, but these improvements did not consistently correspond to superior PROMs. Complication reporting was limited and heterogeneous. Current evidence does not demonstrate a consistent clinical benefit of adding arthroscopic chondral or meniscal treatment to HTO, despite some evidence of improved cartilage findings. Future procedure-specific comparative studies are needed to determine which, if any, arthroscopic adjuncts provide clinically meaningful additive benefit when performed with HTO. Level III.