Effect of concurrent repair of medial meniscal posterior root tears during high tibial osteotomy for medial osteoarthritis during short-term follow-up: a systematic review and meta-analysis

Abstract

Background Medial meniscal posterior root tears (MMPRTs) are frequently associated with medial compartment osteoarthritis, leading to loss of meniscal hoop tension. This study aimed to evaluate the efficacy of concurrent MMPRT repair during high tibial osteotomy (HTO) compared to HTO alone in patients with medial osteoarthritis and MMPRTs. Methods The MEDLINE/PubMed, EMBASE, and Cochrane Library databases were searched for studies reporting on concurrent MMPRT repair during HTO. Pre- and postoperative data were pooled to investigate the treatment effects of concurrent MMPRT repair during HTO, and compare postoperative clinical, radiological, and arthroscopic outcomes including cartilage status and healing event rates according to the arthroscopic classification of MMPRT healing (complete, partial [lax or scar tissue], or failed healing) between HTO patients with and without concurrent MMPRT repair. The random-effect model was used to pool the standardized mean differences, odds ratios (ORs), 95% confidence intervals (CIs), and event rates. Results Seven patient subgroups in six articles divided according to meniscal repair techniques were included in the final analysis. Concurrent MMPRT repair during HTO significantly improved the Lysholm score, while no intergroup differences were observed in the postoperative Lysholm and WOMAC scores, as well as radiological and arthroscopic outcomes. Those who underwent concurrent MMPRT repair showed a higher rate of complete meniscal healing (OR: 4.792, 95% CI, 1.95–11.79), with a pooled rate of complete meniscal healing of 0.327 (95% CI, 0.19–0.46). Conclusion Concurrent MMPRT repair during HTO for medial osteoarthritis with MMPRTs has little benefits on the clinical, radiological, and arthroscopic outcomes during short-term follow-up. Further accumulation of evidence is needed for long-term effects.

Posterior Root Medial Meniscus Tear With Medial Opening Wedge High Tibial Osteotomy: A Step-By-Step Systematic Arthroscopic Repair Technique

“…Several studies do imply that meniscus root repair might not be required. 19 , 20 , 21 HTO alone were not significantly different when compared with the HTO combine with MMR. Otherwise, we recommend the combined meniscus root repair technique with HTO to enhance anatomic healing of the meniscus root and to decrease the load to the medial knee compartment, thus leading to improved MR repair and halting progressive osteoarthritis of the medial knee compartment.…”

“…Several studies do imply that meniscus root repair might not be required. [19][20][21] HTO alone were not significantly different when compared with the HTO combine with Use of the transtibial pull-out technique facilitated a precise anatomic attachment of the structure. The Mason Allen suture technique was used for the posterior medial meniscus root stump (Ethibond Sutures USP 2-0, Ethicon), along with Fiber Tape (UltraTape, Smith-Nephew).…”

“…Further studies of the cartilage regeneration and disease progression after concurrent medial MRR during HTO remain controversial and should be reevaluated in a long-term follow-up period. 19 Some evidence reports that concurrent medial MRR during HTO may not optimize the knee joints in terms of better tibiofemoral contact surface and the restoration of hoop tension. 20 , 21 …”

Radiographic and clinical outcomes of slope and varus correction anterior closing wedge tibial osteotomy for primary anterior cruciate ligament injuries with steep posterior tibial slope, varus knee deformity, and medial meniscal posterior root tears

“…Previous studies have shown that the PTS is affected by both the coronal and sagittal planes: on the coronal plane, Samuelsen et al demonstrated that MMPRT can magnify the effect of the increased PTS on ACLR graft forces. 20 ; On the sagittal plane, the varus deformity is an important prognostic factor in meniscal healing and long-term outcomes following MMPRT repair 14 . Therefore, in this study, we choose MMPRT as one of surgical indications of performing slope-reducing osteotomy.…”

Medial meniscus posterior root tear reconstructed with gracilis autograft improve healing rate and patient reported outcome measures

“…Therefore, studies indicated that surgical treatment should be recommended to patients with high requirements and no to low-grade osteoarthritis [4,5]. Currently, there are several surgical options for the treatment of meniscus root tears, like meniscectomy, meniscal repair, and meniscus root reconstruction.…”