Outcomes of Medial Meniscal Posterior Root Repair During Proximal Tibial Osteotomy: Is Root Repair Beneficial?

PURPOSE

To compare the clinical and radiologic outcomes and arthroscopic findings of proximal tibial osteotomy (PTO) alone versus PTO combined with medial meniscal posterior root repair (MMPRR).

METHODS

Between October 2010 and September 2016, patients who underwent PTO and second-look arthroscopy at a minimum of 24 months postoperatively were reviewed. Patients were divided into group I (isolated PTO), group P (PTO with MMPRR using the pull-out technique), and group F (PTO and MMPRR using the side-to-side repair method). The subjective knee scores were assessed. Radiologic evaluation was based on the Kellgren-Lawrence grade. Healing of medial meniscal posterior root tears (good/loose/scar tissue/failed) and cartilage regeneration (excellent/good/poor) were assessed by arthroscopic examination.

RESULTS

Mean clinical follow-up duration of group I (n = 22), P (n = 25), and F (n = 24) was 28.5 ± 5.7, 27.9 ± 6.2, and 26.3 ± 5.3 months, respectively. At final follow-up, Lysholm score, International Knee Documentation Committee subjective score, and Tegner activity scale significantly improved in all groups (P < .001), and subjective scores did not differ among the groups. The Kellgren-Lawrence grade progression showed no significant differences among 3 groups (P = .461). Good healing of medial meniscal posterior root tears was found in 24% and 12.5% of patients in groups P and F, respectively, and 0 in group I; there were significant differences between groups I and P (P < .001) and groups I and F (P < .001). Excellent cartilage regeneration in the medial femoral condyle and medial tibial plateau was found in 13.6% and 9.1% in group I, 24% and 12% in group P, and 16.7% and 8.3% in group F, respectively, without significant differences.

CONCLUSIONS

Concurrent MMPRR during PTO appears to improve the arthroscopic appearance (healing of MMRPTs and cartilage regeneration) during second-look arthroscopy. However, concurrent MMPRR does not significantly improve clinical and radiologic outcomes at short-term follow-up.

LEVEL OF EVIDENCE

Level III, retrospective comparative study.