Extent of Preoperative Medial Meniscal Extrusion Influences Intermediate-Term Outcomes After Medial Opening-Wedge High Tibial Osteotomy

Abstract

Background:The purpose of the present study was to determine the relationship between preoperative medial meniscal extrusion, as classified according to magnetic resonance imaging (MRI), and medial opening-wedge high tibial osteotomy outcomes at intermediate-term follow-up. Methods:We reviewed the records for 212 patients who had undergone medial opening-wedge high tibial osteotomy for the treatment of medial compartment osteoarthritis between January 2009 and September 2014, with a minimum duration of follow-up of 5 years. Patients were divided into 2 groups according to the presence of pathologic medial meniscal extrusion (>3 mm). Moreover, patients were divided into 4 groups according to MRI Osteoarthritis Knee Score (MOAKS) criteria and relative medial meniscal extrusion values. Associations between the extent of preoperative medial meniscal extrusion and clinical outcomes over a mean duration of follow-up of 8.1 years were evaluated with use of Spearman rank correlation analysis. Regression analyses were performed to determine preoperative characteristics relevant to medial meniscal extrusion. Clinical outcomes were assessed with use of the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Tegner activity scale score.Results: Postoperative KOOS pain scores were significantly different in the pathologic and non-pathologic medial meniscal extrusion groups (69.9 ± 18.0 versus 79.2 ± 11.4, respectively; p < 0.001). Additionally, the degree of preoperative medial meniscal extrusion based on both classification methods and the postoperative KOOS pain score were significantly correlated (r = 20.404 and 20.364; p < 0.001). Despite the inferior clinical outcomes associated with greater preoperative medial meniscal extrusion, medial opening-wedge high tibial osteotomy was associated with significant improvement in all outcome measures between the preoperative and latest follow-up assessments (p < 0.001). Preoperative meniscal patterns, including horizontal flap, complex, and root tears (p = 0.001), and increased Kellgren-Lawrence grade (p < 0.001) were related to the severity of medial meniscal extrusion. The survival rate was 94.8% at a mean of 8.1 years, and survival was not associated with the grade of medial meniscal extrusion as assessed with either classification scheme.Conclusions: At intermediate-term follow-up, greater preoperative medial meniscal extrusion was related to inferior postoperative clinical outcomes, specifically pain, after medial opening-wedge high tibial osteotomy. Despite the inferior results associated with preoperative medial meniscal extrusion, medial opening-wedge high tibial osteotomy was associated with a satisfactory survival rate after a mean of 8.1 years, regardless of the extent of medial meniscal extrusion.

Increased medial meniscus extrusion led to worse clinical outcomes after medial opening-wedge high tibial osteotomy

“…The MME improved more because the varus alignment also improved through MOWHTO surgery, and the pressure in the medial meniscal area had reduced. Some studies have reported an association between the Kellgren–Lawrence grade and the degree of meniscal extrusion [12, 24]. However, no such correlation was found in our study.…”

“…MME is associated with pain in patients with OA of the knee [17,22]. Moreover, prior studies have shown that preoperative and postoperative MMEs are associated with inferior clinical outcomes after MOWHTO [2,11,24]. In the present study, clinical outcomes were better for patients with a postoperative MME of less than 3 mm than for those with more than 3 mm.…”

“…Kim et al [11] and Yang et al [24] reported that clinical outcomes were worse after MOHTO in patients with a greater preoperative MME. Astur et al [2] reported that patients with a postoperative MME of less than 1.5 mm had better clinical outcomes and returned to activity after MOW-HTO.…”

Effect of Prior Knee Arthroscopy on Midterm Outcomes After Medial Opening-Wedge High Tibial Osteotomy: A Propensity Score–Matched Analysis

“…We found an overall survival rate of 96.8% over a mean follow-up of 8 years, which is comparable with previous reports. 4,8,10,46,47 MOWHTO provided a satisfactory survival rate and stable outcomes throughout the study period, despite the presence of prior arthroscopy. There were no intergroup differences in the survival rate based on prior arthroscopy, although a prospective study with a longer follow-up duration is needed to verify this correlation.…”

“…6 The benefits of HTO in the significant improvement of patient-reported outcomes with satisfactory survival have been established. 3,10,16,23,46,47 Despite its advantages, several authors have reported the deterioration of outcomes over time, 1,38,39,48 and a probable relationship between prior arthroscopy and inferior MOWHTO outcomes is concerning. Any arthroscopic procedure can influence postoperative clinical results attributed to persistent effusion, pain, or synovitis.…”