Editorial Commentary: Repairing the Crack and Rebuilding the Foundation? Rethinking Success After High Tibial Osteotomy and Medial Meniscus Root Repair.

Medial meniscus posterior root tears in the varus knee present a challenge of balancing biological repair with biomechanical correction. Recent studies show that combining high tibial osteotomy with root repair improves arthroscopic healing rates compared with osteotomy alone; however, this does not consistently reduce meniscal extrusion or prevent osteoarthritis progression. There is a clinical disconnect between structural healing and functional outcomes, as patient-reported improvement may occur despite ongoing degeneration. We emphasize the importance of patient selection and prompt reconsideration of what defines success in knee preservation surgery.