Clinical Outcomes Following High Tibial Osteotomy with and without Medial Meniscus Posterior Root Repair: A Retrospective Comparative Study

Abstract

Background: High tibial osteotomy (HTO) unloads the medial compartment in selected patients with medial-compartment osteoarthritis and varus alignment. Concomitant medial meniscus posterior root repair (MRR) may restore meniscal function, but its additional clinical benefit remains uncertain. Objective: To compare six-month functional outcomes after HTO alone and HTO + MRR. Methods: This retrospective comparative study included 50 patients treated between 3 February 2024 and 31 August 2026: 25 underwent HTO alone and 25 underwent HTO + MRR. Lysholm and International Knee Documentation Committee (IKDC) scores were recorded preoperatively and at six months. Knee Society Score (KSS) and KSS function score (KSSf) were available only for HTO + MRR. The Wilcoxon signed-rank test was reported for paired comparisons. Results: Mean age was 49.0 ± 3.3 years in HTO alone and 45.5 ± 4.3 years in HTO + MRR. The cohort included 37 women (74%) and 13 men (26%). Lysholm scores changed from 35.7 ± 4.4 to 88.4 ± 3.1 after HTO alone and from 36.3 ± 4.3 to 88.9 ± 4.5 after HTO + MRR; the postoperative between-group P value was 0.65. IKDC scores changed from 33.1 ± 5.1 to 47.2 ± 5.5 after HTO alone and from 34.5 ± 6.8 to 50.0 ± 6.5 after HTO + MRR; the postoperative between-group comparison was reported as P > 0.05. In HTO + MRR, median KSS improved from 43 (range 36–53) to 86 (84–95), and median KSSf from 60 (50–60) to 90 (80–100); both within-group comparisons were reported as P < 0.001. Conclusion: Both groups improved at six months, without a statistically significant between-group difference reported for Lysholm or IKDC. Missing HTO-alone KSS/KSSf data and short follow-up limit conclusions about the incremental effect of MRR. Keywords: high tibial osteotomy; medial meniscus posterior root repair; Lysholm; IKDC; knee osteoarthritis