Abstract
BackgroundMedial 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.MethodsThe 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.ResultsSeven 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).ConclusionConcurrent 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.
Highlights
Medial meniscal posterior root tears (MMPRTs) are frequently associated with medial compartment osteoarthritis, leading to loss of meniscal hoop tension
Second-look arthroscopic findings after high tibial osteotomy (HTO) alone demonstrated that the rate of complete healing of MMRPTs was low, and most of the healed MMPRTs showed lax healing with scars according to the arthroscopic visual classification of MMPRT healing [21,22,23]
A final set of six studies was used in the systematic review and meta-analysis
Summary
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. Medial meniscal posterior root tears (MMPRTs) are frequently associated with medial compartment osteoarthritis (OA), as loss of meniscal hoop tension increases the contact pressure in the medial compartment. Arthroscopic MMPRT repair has been proposed to restore meniscal hoop tension and decelerate medial tibiofemoral articular cartilage degeneration. Only MMPRT repair cannot successfully decompress onesided medial compartment overload without correction of the varus deformities of the lower limbs. Second-look arthroscopic findings after HTO alone demonstrated that the rate of complete healing of MMRPTs was low, and most of the healed MMPRTs showed lax healing with scars according to the arthroscopic visual classification of MMPRT healing [21,22,23]
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