Combined High Tibial Osteotomy and Medial Meniscus Posterior Root Repair May Improve Root Healing Without Consistent Reduction in Meniscal Extrusion or Osteoarthritis Progression: A Systematic Review

Purpose

To evaluate healing rates observed on second‐look arthroscopy (SLA) in patients with medial meniscus posterior root tears treated with isolated high tibial osteotomy (HTO) or HTO combined with root repair (MMPRR) in varus knees. Osteoarthritis (OA) progression, medial meniscus extrusion (ME), and clinical outcomes were assessed as secondary objectives.

Methods

A comprehensive literature search was conducted following the 2020 Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Studies assessing postoperative healing and failure rates on SLA, radiographic progression of knee OA, ME, and clinical outcomes following HTO with or without MMPRR in varus knee were included.

Results

Ten articles met the final inclusion criteria, comprising 459 patients: 148 underwent isolated HTO, and 311 underwent concomitant HTO with MMPRR. SLA was performed in all included patients. The proportion of successfully healed root repairs ranged from 5.9% to 50.0% in the isolated HTO group and 12.5% to 64.9% in the combined HTO + MMPRR group. Partially healed repairs occurred in 25.0% to 40.9% of isolated cases and 0% to 75% of combined cases, whereas failure rates ranged from 20.0% to 59.4% and 0% to 45.5%, respectively.

Postoperatively, ME remained largely unchanged, ranging from 4.2 to 4.5 mm in the isolated HTO group and 3.1 to 5.5 mm in the combined HTO + MMPRR group. Improvement in OA grade was observed in 15% to 20.6% of isolated HTO patients and 4% to 20% of combined group patients, whereas OA progression occurred in 4.5% to 10% and 3.7% to 40.9%, respectively. Arthroscopic evaluation showed cartilage improvement in 17.6% to 40.0% of the isolated group and 3.9% to 53.8% of the combined group, with cartilage deterioration reported in 0% to 9.1% and 0% to 12.0%, respectively.

Conclusions

Healing outcomes following MMPRR varied widely across studies, with outcome ranges showing higher healing rates and lower failure rates in the combined HTO + MMPRR group compared with isolated HTO. Postoperative ME remained largely unchanged in both treatment groups. Although modest improvements in OA grade and cartilage condition were observed, degenerative changes continued to progress in both groups.

Level of Evidence

Level IV, systematic review of Level II to IV studies.