A systematic review and meta-analysis examining alterations in medial meniscus extrusion and clinical outcomes following high tibial osteotomy

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics Pub Date : 2025-02-12 DOI:10.1016/j.jor.2025.01.036

Quan Hu , Jinsong Jiang , Qi Li , Shengsheng Lu , Jiale Xie

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引用次数: 0

Abstract

Background

Medial meniscal extrusion (MME) is both a contributor to and a consequence of medial knee osteoarthritis (OA), with each condition exacerbating the other.High tibial osteotomy (HTO) realigns varus to valgus to alleviate medial compartment stress.This study conducted a systematic review and meta-analysis to evaluate alterations in medial meniscus extrusion values and clinical outcomes following high tibial osteotomy (HTO).

Methods

Eligible studies were identified through a comprehensive search of databases including PubMed, Scopus, Web of Science, Ovid, Embase, Cochrane Library, and CNKI up to May 13, 2024.The primary goal was to assess the values of medial meniscus extrusion before and after HTO surgery.Secondary objectives were other clinical outcomes such as imaging assessments and clinical functional assessments in medial knee OA patients.All meta-analyses used random effects models, assessing between-study heterogeneity in effect sizes with the I2 statistic and P values.A P value under 0.05 was considered statistically significant.

Results

Eight observational studies were included, involving 316 affected knees from 311 patients.The mean difference(MD) in the change in MME values was 2.78 (95% CI, 2.65 to 2.92; P < 0.0001).The other imaging assessments, HKA angle (MD, 8.82; 95% CI, 8.57 to 9.07; P < 0.0001), WBL ratio (MD, −34.98; 95% CI, −36.03 to −33.93; P < 0.0001), medial proximal tibial angle (MD, −8.61; 95% CI, −9.17 to −8.04; P < 0.0001) and posterior tibial slope angle (MD, −1.19; 95% CI, −2.10 to −0.27; P = 0.011), changed obviously in postoperative period.Post-surgery improvements were noted in clinical assessments, including KOOS (MD, −38.41; 95% CI, −39.28 to −37.55; P < 0.0001), Tegner activity scale (MD, −2.55; 95% CI, −2.74 to −2.37; P < 0.0001), Pain VAS (MD, 5.73; 95% CI, 5.44 to 6.02; P < 0.0001), and WOMAC scores (MD, 36.52; 95% CI, 34.46 to 38.59; P < 0.0001) compared to preoperative values.

Conclusions

This systematic review and meta-analysis demonstrated that HTO effectively reduced MME values in patients with medial knee OA and concurrent MME.Simultaneously, HTO corrected lower limb force lines, significantly enhancing imaging and clinical functional assessments in patients.

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一项系统回顾和荟萃分析，检查胫骨高位截骨后内侧半月板挤压的改变和临床结果

背景：内侧半月板挤压（MME）既是内侧膝骨关节炎（OA）的诱因，也是其后果，每一种情况都会加剧另一种情况。胫骨高位截骨术（HTO）重新调整内翻到外翻，以减轻内侧室应力。本研究进行了系统回顾和荟萃分析，以评估胫骨高位截骨术（HTO）后内侧半月板挤压值和临床结果的改变。方法截至2024年5月13日，通过PubMed、Scopus、Web of Science、Ovid、Embase、Cochrane Library、CNKI等数据库进行综合检索，确定符合条件的研究。主要目的是评估HTO手术前后内侧半月板挤压的价值。次要目的是其他临床结果，如影像学评估和内侧膝关节OA患者的临床功能评估。所有meta分析均采用随机效应模型，用I2统计量和P值评估研究间效应大小的异质性。P值小于0.05认为有统计学意义。结果纳入8项观察性研究，涉及311例患者的316个受损膝关节。MME值变化的平均差异（MD）为2.78 (95% CI, 2.65 ~ 2.92；P & lt;0.0001)。其他影像学评价，HKA角(MD, 8.82；95% CI, 8.57 ~ 9.07；P & lt;0.0001)， WBL比(MD,−34.98；95% CI,−36.03 ~−33.93；P & lt;0.0001)，胫骨内侧近端角(MD,−8.61；95% CI,−9.17 ~−8.04；P & lt;0.0001)和胫骨后斜角(MD, - 1.19；95% CI,−2.10 ~−0.27；P = 0.011)，术后变化明显。在临床评估中注意到手术后的改善，包括kos (MD, - 38.41；95% CI,−39.28 ~−37.55；P & lt;0.0001)， Tegner活性量表(MD,−2.55；95% CI,−2.74 ~−2.37；P & lt;0.0001)，疼痛VAS (MD, 5.73；95% CI, 5.44 ~ 6.02；P & lt;0.0001)， WOMAC评分(MD, 36.52；95% CI, 34.46 ~ 38.59；P & lt;0.0001)，与术前值相比。本系统综述和荟萃分析表明，HTO可有效降低膝关节内侧OA合并MME患者的MME值，同时，HTO可纠正下肢力线，显著提高患者的影像学和临床功能评估。

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来源期刊

Journal of orthopaedics ORTHOPEDICS-

CiteScore

3.50

自引率

6.70%

发文量

202

审稿时长

56 days

期刊介绍： Journal of Orthopaedics aims to be a leading journal in orthopaedics and contribute towards the improvement of quality of orthopedic health care. The journal publishes original research work and review articles related to different aspects of orthopaedics including Arthroplasty, Arthroscopy, Sports Medicine, Trauma, Spine and Spinal deformities, Pediatric orthopaedics, limb reconstruction procedures, hand surgery, and orthopaedic oncology. It also publishes articles on continuing education, health-related information, case reports and letters to the editor. It is requested to note that the journal has an international readership and all submissions should be aimed at specifying something about the setting in which the work was conducted. Authors must also provide any specific reasons for the research and also provide an elaborate description of the results.