High tibial osteotomy and concurrent medial meniscus root repair provides improved objective outcomes compared to high tibial osteotomy alone for knee osteoarthritis: A systematic review

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2025-07-18 DOI:10.1002/ksa.12796

Fardis Vosoughi, Pouya Vahedi, Mobina Taghva Nakhjiri, Sohrab Keyhani, Mehran Soleymanha, Robert F. LaPrade, Luke V. Tollefson, Iman Menbari Oskouie

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引用次数: 0

Abstract

Purpose

High tibial osteotomy (HTO) is a cornerstone treatment for medial compartment osteoarthritis (OA) in active patients with varus deformity. However, managing the combination of varus alignment and the medial meniscus posterior root tears (MMPRT) remains controversial. The purpose of this systematic review was to synthesise data from recent comparative studies and evaluate whether adding an MMPRT repair to an HTO enhances outcomes, particularly with respect to meniscal healing, cartilage preservation, and patient function.

Methods

We systematically searched MEDLINE, Embase, Scopus, and Web of Science through April 2025 for studies comparing isolated HTO with HTO plus MMPRT repair. Outcomes included meniscal healing, cartilage status, and patient-reported measures. Risk of bias was assessed using ROBINS-I.

Results

Six studies (506 knees) were included, with 260 undergoing HTO plus MMPRT repair. The reported mean difference in complete meniscus healing ranged from 12.5% to 40% in the HTO plus MMPRT repair group, while it ranged from 0% to 15% in the isolated HTO group. Joint space width (JSW) was reported in three studies, with one study reporting a significant improvement in the HTO plus MMPRT repair group. Cartilage outcomes were superior in three of six studies. One study reported significant functional improvement with a concomitant repair. Despite methodological heterogeneity, all studies had a moderate risk of bias.

Conclusions

While short-term subjective outcomes were similar between isolated HTO and HTO plus MMPRT repair, objective measures, namely higher meniscal healing rates and more stable cartilage scores, consistently favoured the combined approach. In the younger population, even short-term subjective outcomes showed significant improvements along with objective measures and return to sports. Long-term clinical trials are required to determine if these biological advantages translate into a delay in the progression of knee osteoarthritis, particularly in younger, active patients.

Level of Evidence

Level III, systematic review.

Abstract Image

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与单独高位胫骨截骨相比，高位胫骨截骨联合内侧半月板根修复术在治疗膝骨性关节炎方面提供了更好的客观结果：一项系统综述。

目的：胫骨高位截骨术（HTO）是治疗内翻畸形患者内侧骨室骨关节炎（OA）的基础治疗方法。然而，管理内翻对齐和内侧半月板后根撕裂（MMPRT）的组合仍然存在争议。本系统综述的目的是综合最近比较研究的数据，并评估在HTO中加入MMPRT修复是否能提高预后，特别是在半月板愈合、软骨保存和患者功能方面。方法：我们系统地检索MEDLINE、Embase、Scopus和Web of Science到2025年4月，以比较分离HTO与HTO + MMPRT修复的研究。结果包括半月板愈合、软骨状态和患者报告的措施。使用ROBINS-I评估偏倚风险。结果：纳入6项研究（506个膝关节），其中260例接受HTO + MMPRT修复。据报道，在HTO + MMPRT修复组中，半月板完全愈合的平均差异为12.5%至40%，而在单独的HTO组中，平均差异为0%至15%。三项研究报告了关节间隙宽度（JSW），其中一项研究报告了HTO + MMPRT修复组的显著改善。6项研究中有3项的软骨预后较好。一项研究报告了伴随修复的显著功能改善。尽管方法学存在异质性，但所有研究均存在中等偏倚风险。结论：虽然孤立HTO和HTO + MMPRT修复的短期主观结果相似，但客观指标，即更高的半月板愈合率和更稳定的软骨评分，始终倾向于联合方法。在较年轻的人群中，即使是短期的主观结果也显示出显著的改善，随着客观测量和重返运动。需要长期的临床试验来确定这些生物学优势是否转化为延缓膝关节骨关节炎的进展，特别是在年轻、活跃的患者中。证据等级：III级，系统评价。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).