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.

PURPOSE: 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).

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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 OF EVIDENCE: Level II, lesser-quality randomized controlled trial.