Comparative study between isolated medial meniscus root repair versus open-wedge high tibial osteotomy versus combined approach in patients with root tears, 2-year follow-up

Background
Medial meniscus root tears usually lead to loss of hoop tension of the meniscus and result in high-contact pressure in the medial compartment of the knee. Surgical management of those types of tears is mandatory to restore hope tension and to save medial compartment. This study was done to evaluate the necessity of medial root repair with high tibial osteotomy (HTO) for treatment of medial meniscus root tears.


Patients and methods
This is a prospective comparative study over 60 patients with medial meniscal root tears. The patients were classified randomly into three groups. The first group (group A) was treated with isolated medial meniscus posterior root tear repair (n=20). The second group (group B) was treated with isolated open-wedge high HTO (n=20). The third group (group C) was treated using combined medial meniscal root repair with high tibial open-wedge osteotomy (n=20). A clinical evaluation was made using range of motion (ROM) and pain assessment. Functional evaluation was done using Lysholm score and Hospital for Special Surgery score. Radiological evaluation was done using follow-up standing Lyon–Schuss films.


Results
Regarding the patients’ reported outcome measures, one-way analysis of variance was calculated to compare means between the three groups. The results of isolated root repair were the worst and there was no statistically significant difference between groups B and C.


Conclusion
Results recommend isolated HTO as a solo fast-attack procedure with reliable durable clinical and radiological outcomes for the treatment of root tears of the posterior horn of the medial meniscus.