Combined medial meniscus repair, centralization, and high tibial osteotomy are associated with improved clinical, radiological, and arthroscopic outcomes in patients with posterior root tears and varus alignment.

Purpose: To evaluate the radiological, clinical, and arthroscopic outcomes following meniscal centralization combined with pull-out repair and open-wedge high tibial osteotomy (OWHTO) in patients with medial meniscal posterior root tear (MMPRT) and varus alignment.

Methods: We retrospectively analyzed patients who underwent OWHTO between 2017 and 2022, including those with MMPRT and varus alignment who received meniscal centralization and transtibial pull-out repair, with a minimum 2-year follow-up. Clinical and radiographic outcomes, including medial joint space width (mJSW) in the Rosenberg view, were evaluated. Second-look arthroscopy, performed at the time of plate removal (1 year after surgery), evaluated meniscal healing and cartilage status. Medial meniscus extrusion (MME) was classified at the initial surgery and second-look arthroscopy. The cohort-specific minimal clinically important difference (MCID) was calculated.

Results: Of the 48 eligible patients, 37 were available for follow-up and were included in the analysis, with a mean follow-up of 45.7 ± 12.0 months (range: 24-71 months). The flexion angle and all clinical scores were significantly improved. MCID was achieved in 92.9% of patients, according to the International Knee Documentation Committee (IKDC), and in >80% of patients for all Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales, except for the KOOS Sport. mJSW increased from 2.7 ± 1.0 mm before surgery to 2.9 ± 1.0 mm at 2 years after surgery (p = .046). Complete meniscal healing was observed in 80.6%, with significant improvements in the International Cartilage Repair Society scores for medial femoral condyle and medial tibial plateau (p = .011, p = .006). MME was improved in 83.3% of patients.

Conclusion: Combined with pull-out repair, meniscal centralization and OWHTO significantly improved clinical, radiological, and arthroscopic outcomes at short-term follow-up, with a high proportion of patients achieving MCID thresholds in the Lysholm score, IKDC subjective score, and KOOS subscales.