Combined high tibial osteotomy and root repair improves patient-reported outcomes in medial meniscus posterior root tears: A systematic review and meta-analysis
Bibliographic record
Abstract
Importance High tibial osteotomy (HTO) is a well-established joint-preserving surgery for varus knees with medial compartment overload. There is a growing interest in combining HTO with meniscal root repair (HTO-MRR) to address both the varus malalignment and the meniscal deficiency caused by medial meniscus posterior root tears (MMPRTs). Aim This systematic review and meta-analysis aimed to synthesise current evidence on the clinical, radiographic, and arthroscopic outcomes following HTO-MRR for isolated MMPRTs. Where available, comparative data with HTO alone were analysed as a secondary objective. Evidence review MEDLINE, EMBASE, and CINAHL were searched from inception to June 5, 2025 for studies on HTO-MRR for isolated MMPRTs. Data from comparative studies with HTO alone were pooled using random-effects models. Outcomes included patient-reported outcomes (PROMs), range of motion, radiographic parameters, and healing rates. Findings Thirteen studies, comprising 725 patients with degenerative MMPRTs (67% female), met the inclusion criteria. Of these, 459 underwent HTO-MRR and 266 underwent HTO alone. The mean age was 54 ± 9 years (range, 41–65) and a mean follow-up of 25 months (range, 15–66). The baseline varus angles in HTO-MRR patients ranged from 3.3° ± 1.2°–6.9° ± 2.5°. Weighted means for postoperative Lysholm, Hospital for Special Surgery (HSS), and International Knee Documentation Committee (IKDC) scores were 86 (range, 78–95), 85 (range, 81–85), and 68 (range, 50–81), respectively. The minimal clinically important difference (MCID) thresholds of 8.9, 5.4, and 12.5 for these PROMs, respectively, were exceeded. There was a statistically significant improvement in HSS (standardised mean difference [SMD]: 0.59; 95% CI 0.34–0.84; I 2 = 0%; p < 0.01) and IKDC scores (SMD: 0.31; 95% CI 0.01–0.61; I 2 = 0%; p = 0.04) in HTO-MRR versus HTO alone. Complete meniscal healing rates following HTO-MRR ranged from 13% to 60%, with a weighted mean of 33%. Radiographic parameters, including Kellgren–Lawrence grade, meniscal extrusion, and joint space width, showed no statistically significant between-group differences (all p > 0.05). Conclusion and Relevance HTO-MRR demonstrated improved HSS and IKDC scores compared to HTO alone in isolated MMPRTs. While no short-to mid-term differences in osteoarthritic progression were observed, the current level of evidence remains low, and the potential joint-preserving benefits of HTO-MRR warrant investigation in long-term prospective studies. Level of Evidence IV.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.025 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.015 | 0.023 |
| Bibliometrics | 0.005 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".