High tibial osteotomy with versus without medial meniscus posterior root repair: A systematic review and meta-analysis
Ashraf Mohamed Attia ElazabBackground and Aims:
Medial meniscus posterior root tears (MMPRTs) disrupt hoop tension and accelerate medial compartment degeneration, frequently coexisting with varus malalignment. High tibial osteotomy (HTO) reduces medial compartment load; however, whether concomitant root repair provides additional clinical or structural benefit remains uncertain. This systematic review and meta-analysis compared outcomes of HTO performed with versus without MMPRT repair.
Materials and Methods:
A systematic search of PubMed, Scopus, Embase, and the Cochrane Library was conducted through January 2026 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Comparative studies evaluating HTO with and without MMPRT repair were included. Extracted data comprised patient characteristics, functional outcomes (Lysholm, International Knee Documentation Committee [IKDC], Hospital for Special Surgery), and radiologic parameters including meniscal extrusion, joint space width (JSW), and Kellgren–Lawrence osteoarthritis progression. Pooled mean differences (MD) or odds ratios (OR) with 95% confidence intervals (CI) were calculated using random-effects models. Study quality was assessed using the Newcastle–Ottawa scale.
Results:
Five studies encompassing 373 knees met the inclusion criteria. Pooled analysis demonstrated significantly superior functional outcomes in the HTO with root repair group, with higher Lysholm scores (MD = +6.35, 95% CI 4.94–7.76; I 2 = 0%) and IKDC scores (MD = +5.42, 95% CI 3.21–7.63; I 2 = 0%). Meniscal extrusion was significantly reduced following combined surgery (MD = −0.32, 95% CI −0.45–−0.19; p < 0.00001; I 2 = 0%). No significant difference was observed in JSW (MD = 0.08, 95% CI −0.20 to 0.36; I 2 = 0%). Patients undergoing HTO with repair demonstrated lower odds of radiographic osteoarthritis progression (OR = 0.58, 95% CI 0.33–0.89; p = 0.02; I 2 = 0%). Subgroup analyses suggested greater benefit among patients younger than 60 years and those with early to moderate cartilage degeneration.
Conclusion:
Concomitant MMPRT repair performed with HTO is associated with improved functional recovery, reduced meniscal extrusion, and lower radiographic progression of osteoarthritis compared with HTO alone. The combined approach appears biomechanically advantageous in restoring joint load distribution and enhancing joint preservation. High-quality randomized controlled trials with long-term follow-up are required to confirm durability and refine patient selection.