J Korean Orthop Assoc.  2023 Jun;58(3):208-215. 10.4055/jkoa.2023.58.3.208 .

Treatments for Medial Meniscus Posterior Root Tear during Medial Opening Wedge High Tibial Osteotomy: Conservative or Pullout Suture or FasT-Fix All-Inside Suture

• Kim SG
• Bae JH
• Jung JW

• KMID: 2543268
• DOI: http://doi.org/10.4055/jkoa.2023.58.3.208

Abstract

Medial opening wedge high tibial osteotomy (MOHTO) is a well-established treatment for medial osteoarthritis of the knee joint in relatively young and active patients. Although medial meniscus posterior horn root tears (MMPRTs) are often observed during high tibial osteotomy, the optimal treatment for this condition is still controversial. Theoretically, anatomical repair of the MMPRTs can restore the peak contact pressure and may help delay the progression of osteoarthritis. However, for the successful healing of the MMPRTs, it is essential to evaluate the status of the articular cartilage and meniscus (repairability, degenerative changes, extrusion, etc.), the target weight-bearing position postoperatively, and the surgeon’s proficiency. Recently, the transtibial pullout suture has been the most commonly performed treatment for MMPRTs. However, the transtibial tunnel for the pullout suture may overlap with the location of the osteotomy or the plate for the MOHTO. To overcome this problem, alternative techniques that involve changing the position of the transtibial tunnel have been introduced. All-inside sutures using the FasT-Fix suture device can also be used because they do not require a transtibial tunnel. Recent clinical studies have reported that the concurrent repair of MMPRTs during MOHTOs could improve their healing rate, but this did not significantly improve short-term clinical outcomes compared to the conservative treatment for MMPRTs. Since these clinical studies evaluated clinical outcomes at short-term follow-ups, studies involving long-term follow-ups are needed to determine the optimal treatment of an MMPRT occurring during MOHTO.

Keyword

medial opening wedge high tibial osteotomy; medial meniscus posterior horn root tear; pullout suture; FasT-Fix; conservative treatment