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. 2020 Apr 17;8(4):2325967120913531.
doi: 10.1177/2325967120913531. eCollection 2020 Apr.

Medial Opening Wedge High Tibial Osteotomy Decreases Medial Meniscal Extrusion and Improves Clinical Outcomes and Return to Activity

Diego Costa Astur  1 , Joao Victor Novaretti  2 , Marcelo Lins Gomes  3 , Adilson Góes Rodrigues Jr  3 , Camila Cohen Kaleka  3 , Elton Luiz Batista Cavalcante  3 , Pedro Debieux  3 , Joicemar Tarouco Amaro  3 , Moises Cohen  4
Affiliations

Medial Opening Wedge High Tibial Osteotomy Decreases Medial Meniscal Extrusion and Improves Clinical Outcomes and Return to Activity

Diego Costa Astur et al. Orthop J Sports Med. .

Abstract

Background: Medial meniscal extrusion (MME) is defined as displacement of the meniscus that extends beyond the tibial margin. Knee varus malalignment increases MME.

Purpose/hypothesis: The purpose of this study was to quantify MME before and after medial opening wedge high tibial osteotomy (HTO) and to correlate the reduction of MME with clinical outcomes and return to activity. It was hypothesized that MME would decrease after HTO and that patients with lower MME after surgery would have improved clinical outcomes and return to activity at short-term follow-up.

Study design: Case series; Level of evidence, 4.

Methods: This study included 66 patients who underwent HTO to correct the anatomic axis with a minimum follow-up of 2 years. MME was measured using magnetic resonance imaging preoperatively and 6 weeks after surgery (study protocol). Patients were assessed preoperatively and postoperatively with the Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS) score for pain, and Tegner score.

Results: The mean ± SD preoperative and postoperative MME values were 3.9 ± 0.6 mm and 0.9 ± 0.5 mm, respectively. At 2 years after surgery, KOOS, pain VAS, and Tegner scores were higher than those found preoperatively (P < .001). Patients with less than 1.5 mm of MME after surgery had better clinical outcomes and return to activity compared with patients who had MME of 1.5 mm or more (P < .05).

Conclusion: Medial opening wedge HTO decreased MME after 6 weeks and improved clinical outcomes and return to activity at a minimum 2-year follow-up. Additionally, patients with postoperative MME of less than 1.5 mm had better clinical outcomes and return to activity compared with patients who had postoperative MME of 1.5 mm or more.

Keywords: high tibial osteotomy; knee function; meniscal extrusion; return to activities.

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Conflict of interest statement

The authors declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Flowchart of selection for all patients evaluated. BMI, body mass index. A few patients fulfill more than one exclusion criteria during sample selection.
Figure 2.
Figure 2.
Preoperative (A and C) and postoperative (B and D) measurements of medial meniscal extrusion: coronal section of meniscus showing the best image of the tibial eminence. A tangent line was drawn from the edge of the medial tibial plateau to the medial femoral condyle (the white dashed line).
See this image and copyright information in PMC

Comment in

References

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