Choe Jung-Su, Bin Seong-Ii, Kim Jong-Min, Lee Bum-Sik, Song Ju-Ho, Cho Hyung-Kwon, Kee Tae-Hong
Department of Orthopedic Surgery, Cheju Halla General Hospital, Jeju, Republic of Korea.
Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Orthop J Sports Med. 2023 May 18;11(5):23259671231166920. doi: 10.1177/23259671231166920. eCollection 2023 May.
Medial opening-wedge high tibial osteotomy (MOWHTO) reduces contact stress by altering the weightbearing axis from the medial to the lateral compartment, relieves knee pain, and slows the progression of osteoarthritis.
PURPOSE/HYPOTHESIS: To evaluate whether the volume of the medial meniscus affects outcomes after MOWHTO. It was hypothesized that reduced medial meniscal volume would be associated with worse midterm clinical and radiographic outcomes.
Cohort study; Level of evidence, 3.
Included were 59 patients who underwent MOWHTO and had ≥4 years of follow-up data. The mean follow-up period was 66.5 ± 15.1 months (range, 48-110 months). The cohort was classified into 3 groups according to the status of the medial meniscus on arthroscopic examination before osteotomy: no meniscal tear, degenerative tear leading to partial meniscectomy, and degenerative tear leading to subtotal meniscectomy. The Hospital for Special Surgery score and Knee Society objective and functional scores were compared among the groups at 2 time points (preoperative and latest follow-up), and the medial joint space width (JSW) was compared among the groups at 3 time points (preoperative, 1 year postoperative, and latest follow-up).
Overall, 9 patients had no meniscal tear, 20 patients underwent partial meniscectomy, and 30 patients underwent subtotal meniscectomy. The clinical scores improved significantly from preoperatively to the latest follow-up ( ≤ .001 for all), with no significant difference among the groups. Post hoc analysis indicated that at the latest follow-up, JSW was significantly lower in the subtotal meniscectomy group compared with the no-tear group on both 45° of flexion posterior-anterior (2.5 ± 1.3 vs 3.9 ± 1.8 mm; = .004) and anterior-posterior (3.4 ± 1.1 vs 4.5 ± 0.9 mm; = .011) radiographs.
Subtotal meniscectomy of the medial meniscus performed during arthroscopic examination with MOWHTO was associated with decreased JSW at midterm follow-up. Efforts should be made to preserve the medial meniscus as much as possible during MOWHTO.
内侧开口楔形高位胫骨截骨术（MOWHTO）通过将负重轴从内侧间室改变至外侧间室来降低接触应力，缓解膝关节疼痛，并减缓骨关节炎的进展。
目的/假设：评估内侧半月板的体积是否会影响MOWHTO术后的疗效。假设内侧半月板体积减小与中期临床和影像学疗效较差相关。
队列研究；证据等级，3级。
纳入59例行MOWHTO且有≥4年随访数据的患者。平均随访期为66.5±15.1个月（范围48 - 110个月）。根据截骨术前关节镜检查时内侧半月板的状况，将该队列分为3组：无半月板撕裂、导致部分半月板切除术的退行性撕裂、导致次全半月板切除术的退行性撕裂。在2个时间点（术前和最新随访）比较各组间的特种外科医院评分以及膝关节协会客观和功能评分，并在3个时间点（术前、术后1年和最新随访）比较各组间的内侧关节间隙宽度（JSW）。
总体而言，9例患者无半月板撕裂，20例患者接受了部分半月板切除术，30例患者接受了次全半月板切除术。从术前到最新随访，临床评分均显著改善（所有P≤0.001），各组间无显著差异。事后分析表明，在最新随访时，次全半月板切除术组在屈膝45°时的前后位（2.5±1.3 vs 3.9±1.8 mm；P = 0.004）和前后位（3.4±1.1 vs 4.5±0.9 mm；P = 0.011）X线片上的JSW均显著低于无撕裂组。
在MOWHTO关节镜检查期间进行内侧半月板次全切除术与中期随访时JSW降低相关。在MOWHTO期间应尽可能努力保留内侧半月板。
