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Abstract Background Medial meniscal posterior root tear (MMPRTs) is a common lesion of the knee joint, and repair surgery is a well-established treatment option. However, patients with obvious varus alignment are at an increased risk for MMPRT and can suffer from a greater degree of medial meniscus extrusion, which leads to the development of osteoarthritis following repair. The efficacy of high tibial osteotomy (HTO) as a means of correcting this malformation, and its potential benefits for MMPRT repair, remains unclear. Purpose To explore whether HTO influenced the outcome of MMPRT repair in clinical scores and radiological findings. Study design Systematic review. Methods According to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guidelines, we searched PubMed, Embase, Web of Science, and the Cochrane Library databases for studies reporting the outcomes of MMPRT repair and extracted data about characteristics of patients, clinical functional scores and radiologic outcomes. One reviewer extracted the data and 2 reviewers assessed the risk of bias and performed a synthesis of the evidence. Articles were eligible if they reported the results of MMPRT repair with exact mechanical axis (registered in the International Prospective Register of Systematic Reviews, CRD42021292057). Results Fifteen studies with 625 cases of high methodological quality were identified. Eleven studies were assigned to the MMPRT repair group (M) with 478 cases performing MMPRT repair only, and others belonged to the MMPRT repair and HTO group (M and T) performing HTO and MMPRT repair. Most of the studies had significantly improved clinical outcome scores, especially in M groups. And the radiologic outcomes showed that the osteoarthritis deteriorated in both groups with similar degree in about 2-year follow-up. Conclusion HTO is a useful supplement in treating MMPRT patients with severe osteoarthritis and the clinical and radiological outcomes were similar with MMPRT repair alone. Which would be better for patients’ prognosis generally, performing MMPRT repair alone or a combination of HTO and MMPRT repair, was still controversial. We suggested taking K-L grade into account. Large-scale randomized control studies were called for in the future to help make better clinical decisions. Level of evidence III

Background: Medial meniscal posterior root tear (MMPRTs) is a common lesion of the knee joint, and repair surgery is a well-established treatment option. However, patients with obvious varus alignment are at an increased risk for MMPRT and can suffer from a greater degree of medial meniscus extrusion, which leads to the development of osteoarthritis following repair. The efficacy of high tibial osteotomy (HTO) as a means of correcting this malformation, and its potential benefits for MMPRT repair, remains unclear. Purpose: To explore whether HTO influenced the outcome of MMPRT repair in clinical scores and radiological findings. Study design: Systematic review. Methods: According to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guidelines, we searched PubMed, Embase, Web of Science, and the Cochrane Library databases for studies reporting the outcomes of MMPRT repair and extracted data about characteristics of patients, clinical functional scores and radiologic outcomes. One reviewer extracted the data and 2 reviewers assessed the risk of bias and performed a synthesis of the evidence. Articles were eligible if they reported the results of MMPRT repair with exact mechanical axis (registered in the International Prospective Register of Systematic Reviews, CRD42021292057). Results: Fifteen studies with 625 cases of high methodological quality were identified. Eleven studies were assigned to the MMPRT repair group (M) with 478 cases performing MMPRT repair only, and others belonged to the MMPRT repair and HTO group (M and T) performing HTO and MMPRT repair. Most of the studies had significantly improved clinical outcome scores, especially in M groups. And the radiologic outcomes showed that the osteoarthritis deteriorated in both groups with similar degree in about 2-year follow-up. Conclusion: HTO is a useful supplement in treating MMPRT patients with severe osteoarthritis and the clinical and radiological outcomes were similar with MMPRT repair alone. Which would be better for patients' prognosis generally, performing MMPRT repair alone or a combination of HTO and MMPRT repair, was still controversial. We suggested taking K-L grade into account. Large-scale randomized control studies were called for in the future to help make better clinical decisions. Level of evidence: III [ABSTRACT FROM AUTHOR]

Introduction: The influence of patient demographic factors in predicting the success and failure of HTO remains largely unknown. Objectives: To determine factors associated with success or failure after high tibial osteotomy (HTO) for unicompartmental knee pain with varus deformity at a minimum of 2-year follow-up. Methods: A prospectively collected HTO outcomes registry was queried for patients undergoing HTO. Demographic, preoperative, intraoperative, radiographic, and postoperative data were collected. Patient factors were analyzed for their association with HTO failure, which was defined as conversion to uni- or total knee arthroplasty. Results: Seventy-five patients were identified (n = 58 males; n = 17 females) with a mean age of 37.3 ± 8.7 years at surgery and average follow-up of 5.5 ± 3.8 years. Forty-eight percent (n = 36) of patients underwent reoperation, 28% (n = 21) underwent hardware removal, and 17% (n = 13) converted to arthroplasty. Increased body mass index (BMI) (> 30 kg/m2) (P = .025) and age > 45 years (P = .020) were associated with HTO failure, while performance of concomitant procedures decreased failure probabilities (P = .008). Conclusion: s: High tibial osteotomy is an effective procedure for symptomatic patients with varus deformity, associated with a significant improvement in PROs, a moderate complication rate, and a high survival rate. Reoperation rates remain common, while failure rates requiring conversion to arthroplasty necessitate HTO be performed in appropriately selected patients. Performance of concomitant joint preservation procedures at the time of HTO was protective against HTO failure, while greater patient age and BMI were associated with HTO failures. Level of Evidence: Level 4, Case series

Introduction: The threshold values needed to achieve MCID and PASS following HTO with or without concomitant procedures are not well known. Objectives: To determine values and variables predictive for achieving the minimally clinically important difference (MCID) and patient acceptable symptom state (PASS) of patient-reported outcome (PRO) scores following high tibial osteotomy (HTO) with or without associated restoration procedures for the correction of varus deformity. Methods: A prospectively collected HTO outcomes registry was retrospectively reviewed for patients who underwent HTO between 2001 and 2018. Collected PROs included International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Lysholm scores. A distribution-based approach was used to calculate MCID, and an anchor-based approach was used for the calculation of PASS. Results: Fifty-five patients were identified (n = 43 males; n = 12 females) with a mean age of 37.9 ± 9.0 years at surgery and average follow-up of 3.3 ± 3.1 years. The MCID and PASS for IKDC were calculated as 12.5 and 40.23, respectively. MCID and PASS values for each of the KOOS subscales were as follows: symptoms: 9.9 and 71.43; pain: 11.3 and 72.22; daily living: 12.0 and 77.94; sports: 16.0 and 40; quality of life: 15.1 and 56.25, respectively. Conclusions: Based on calculated values for MCID and PASS following HTO using IKDC and KOOS subscales, higher preoperative PROs, prior medial meniscectomy, higher BMI, concomitant ACL reconstruction and worker's compensation status were associated with failure to achieve clinically significant outcomes. Prior ACL reconstruction was found to be predictive of MCID for KOOS-symptoms.

Purpose of Review: Coronal and sagittal malalignment in the setting of anterior cruciate ligament (ACL) deficiency alters knee biomechanics and is shown to increase stress and strain on the native ACL and on the ACL graft during reconstruction. The purpose of this review was to determine the role and indications of high tibial osteotomy to correct coronal and/or sagittal plane malalignment with ACL reconstruction. Recent Findings: Recent literature illustrates that an increase in varus malalignment and increased posterior tibial slope increases the biomechanical stress that is seen in a native or reconstructed ACL graft. It has been proposed to correct the sagittal and coronal malalignment by employing a high tibial osteotomy either prior to or at the time of ACL reconstruction to correct these deformities and to decrease the stress placed on the reconstructed ACL graft. Summary: The use of high tibial osteotomy for deformity correction creates a more stable knee for ACL reconstruction and has been shown to have good outcomes with regard to post-operative pain, stability, satisfaction scores, and function. [ABSTRACT FROM AUTHOR]

Purpose: Varus alignment is known as one of the major causes of medial compartment osteoarthritis (OA). Medial meniscus extrusion also plays a critical role in the in the development of OA. However, studies on the exact relationship between alignment parameters and medial meniscus extrusion are limited. Therefore, this study aimed to investigate this relationship in patients with knee OA.Methods: Based on a retrospective analysis of the outpatient magnetic resonance imaging (MRI) database, 190 knees were identified to be examined using weight-bearing, whole-leg radiographs and MRIs within 3 months from the first consultation. Subsequently, various parameters of lower leg alignment were measured, which affected the knee varus in radiographs. Finally, a statistical analysis was performed to assess the relationships between the OA grade, distance of medial meniscus extrusion (MME), and alignment parameters; hip-knee-ankle angle (HKAA), percentage of mechanical axis (% MA), medial proximal tibial angle (MPTA), and joint line convergence angle (JLCA). The subjects were divided according to the presence or absence of MME (Group A: MME distance below 3 mm, Group B: MME distance 3 mm and above) to assess the differences in each alignment parameter correlated with MME distance between the groups.Results: MME distance significantly increased with OA grade progression. HKAA, % MA, MPTA, and JLCA significantly correlated with medial meniscus extrusion distance (r = - 0.21, - 0.23, - 0.16, 0.3, respectively). Multiple regression analysis of each significant alignment combined with age, sex, and body mass index revealed that HKAA, % MA, MPTA, and JLCA were significant independent factors of MME distance (P = 0.008, 0.0026, 0.011, 0.0001, respectively). These significant findings were reinforced in group B. In contrast, the correlation between alignment parameters and medial meniscus extrusion distance was not significant in group A.Conclusion: Varus alignment factors are related to MME distance especially in extruded meniscus knees, as the OA grade progressed. Therefore, the coexistence of varus alignment and MME can be the risk factors for OA progression. As the low MPTA was an independent alignment factor for generating varus alignment, patients with osteoarthritis of the knee with both, low MPTA and MME could be the appropriate candidates for early intervention by high tibial osteotomy.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]