Skip to main content

Increased medial meniscus extrusion led to worse clinical outcomes after medial opening-wedge high tibial osteotomy

Knee Surgery, Sports Traumatology, Arthroscopy (2022)Cite this article

Abstract

Purpose

Given that no studies have assessed the correlation between improvements in medial meniscus extrusion (MME) and clinical outcomes after medial opening-wedge high tibial osteotomy (MOWHTO), the present study aimed to measure the improvement in MME after MOWHTO and to investigate the correlation between the remaining postoperative MME and MOWHTO clinical outcomes by subgroup analysis.

Methods

This study included 79 patients (80 knees) who underwent MOWHTO with a minimum follow-up of 2 years. MME was measured pre- and postoperatively through magnetic resonance imaging after an average of 19.8 months following MOWHTO surgery. Clinical outcomes were evaluated according to the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Tegner Activity Scale, and the Short-Form 36 questionnaire. In subgroup analysis, postoperative MME was classified into non-pathologic (≤ 3 mm) and pathologic (> 3 mm) groups. The clinical outcomes of the two groups were compared using Mann–Whitney U tests. A regression analysis was performed to determine the preoperative and postoperative characteristics associated with the improvement of MME.

Results

The mean (± standard deviation) values for pre- and postoperative MME were 3.6 (± 1.8) mm and 2.8 (± 1.5) mm, respectively (p < 0.001). In the subgroup analysis of postoperative MME, the non-pathologic group showed better improvement of KOOS than the pathologic group. Preoperative hip-knee-ankle angle was correlated with the improvement of medial meniscal extrusion in both univariate (p = 0.049) and multivariate (p = 0.015) analyses.

Conclusion

The MME improved after MOWHTO, and the clinical outcomes were better for patients with a postoperative MME of less than 3 mm than for those with more than 3 mm. MME improvement after MOWHTO was correlated with preoperative varus alignment of the lower extremities.

Level of evidence

III (Retrospective cohort study).

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Abbreviations

MME:

Medial meniscus extrusion

MOWHTO:

Medial opening-wedge high tibial osteotomy

KOOS:

Knee injury and osteoarthritis outcome score

HKA angle:

Hip-knee-ankle angle

HTO:

High tibial osteotomy

OA:

Osteoarthritis

MRI:

Magnetic resonance imaging

ICC:

Intra-class correlation coefficient

SF-36:

Short-Form 36

BMI:

Body mass index

K-L:

Kellgren–Lawrence

PCS:

Physical component summary

MCS:

Mental component summary

MPTA:

Medial proximal tibial angle

PTSA:

Posterior tibial slope angle

MCID:

Minimal clinically important difference

References

  1. Agneskirchner JD, Hurschler C, Wrann CD, Lobenhoffer P (2007) The effects of valgus medial opening wedge high tibial osteotomy on articular cartilage pressure of the knee: a biomechanical study. Arthroscopy 23:852–861

    Article  Google Scholar 

  2. Astur DC, Novaretti JV, Gomes ML, Rodrigues AG Jr, Kaleka CC, Cavalcante ELB et al (2020) Medial opening wedge high tibial osteotomy decreases medial meniscal extrusion and improves clinical outcomes and return to activity. Orthop J Sports Med 8:2325967120913531

    PubMed  PubMed Central  Google Scholar 

  3. Badlani JT, Borrero C, Golla S, Harner CD, Irrgang JJ (2013) The effects of meniscus injury on the development of knee osteoarthritis: data from the osteoarthritis initiative. Am J Sports Med 41:1238–1244

    Article  Google Scholar 

  4. Bae JK, Kim JH, Kim KI, Lee SH, Seo DW (2022) Serial improvement of medial meniscus extrusion following medial open-wedge high tibial osteotomy does not correlate with clinical outcomes and arthroscopic articular cartilage improvement. Arthroscopy 38:928–935

    Article  Google Scholar 

  5. Berthiaume M-J, Raynauld J-P, Martel-Pelletier J, Labonté F, Beaudoin G, Bloch DA et al (2005) Meniscal tear and extrusion are strongly associated with progression of symptomatic knee osteoarthritis as assessed by quantitative magnetic resonance imaging. Ann Rheum Dis 64:556–563

    Article  Google Scholar 

  6. Costa CR, Morrison WB, Carrino JA (2004) Medial meniscus extrusion on knee MRI: is extent associated with severity of degeneration or type of tear? Am J Roentgenol 183:17–23

    Article  Google Scholar 

  7. Crema MD, Roemer FW, Felson DT, Englund M, Wang K, Jarraya M et al (2012) Factors associated with meniscal extrusion in knees with or at risk for osteoarthritis: the multicenter osteoarthritis study. Radiology 264:494–503

    Article  Google Scholar 

  8. Dugdale TW, Noyes FR, Styer D (1992) Preoperative planning for high tibial osteotomy. The effect of lateral tibiofemoral separation and tibiofemoral length. Clin Orthop 274:248–264

    Article  Google Scholar 

  9. Fujisawa Y, Masuhara K, Shiomi S (1979) The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am 10:585–608

    Article  CAS  Google Scholar 

  10. Jung W-H, Takeuchi R, Chun C-W, Lee J-S, Ha J-H, Kim J-H et al (2014) Second-look arthroscopic assessment of cartilage regeneration after medial opening-wedge high tibial osteotomy. Arthroscopy 30:72–79

    Article  Google Scholar 

  11. Kim MS, Koh IJ, Kim CK, Choi KY, Kang KH, In Y (2020) Preoperative medial meniscal extrusion is associated with patient-reported outcomes after medial opening wedge high tibial osteotomy. Am J Sports Med 48:2376–2386

    Article  Google Scholar 

  12. Lee DH, Lee BS, Kim JM, Yang KS, Cha EJ, Park JH et al (2011) Predictors of degenerative medial meniscus extrusion: radial component and knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 19:222–229

    Article  Google Scholar 

  13. Lee SC, Am Jung K, Nam CH, Jung SH, Hwang SH (2010) The short-term follow-up results of open wedge high tibial osteotomy with using an Aescula open wedge plate and an allogenic bone graft: the minimum 1-year follow-up results. Clin Orthop Surg 2:47–54

    Article  Google Scholar 

  14. Lobenhoffer P, Agneskirchner JD (2003) Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 11:132–138

    Article  Google Scholar 

  15. Mucha A, Dordevic M, Hirschmann A, Rasch H, Amsler F, Arnold MP et al (2015) Effect of high tibial osteotomy on joint loading in symptomatic patients with varus aligned knees: a study using SPECT/CT. Knee Surg Sports Traumatol Arthrosc 23:2315–2323

    Article  Google Scholar 

  16. Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee injury and osteoarthritis outcome score (KOOS)—development of a self-administered outcome measure. J Orthop Sports Phys Ther 28:88–96

    Article  CAS  Google Scholar 

  17. Roubille C, Raynauld J-P, Abram F, Paiement P, Dorais M, Delorme P et al (2014) The presence of meniscal lesions is a strong predictor of neuropathic pain in symptomatic knee osteoarthritis: a cross-sectional pilot study. Arthritis Res Ther 16:1–7

    Article  Google Scholar 

  18. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop 198:42–49

    Article  Google Scholar 

  19. Van Thiel GS, Frank RM, Gupta A, Ghodadra N, Shewman EF, Wang VM et al (2011) Biomechanical evaluation of a high tibial osteotomy with a meniscal transplant. J Knee Surg 24:045–054

    Article  Google Scholar 

  20. Villegas DF, Hansen TA, Liu DF, Donahue TLH (2008) A quantitative study of the microstructure and biochemistry of the medial meniscal horn attachments. Ann Biomed Eng 36:123–131

    Article  Google Scholar 

  21. Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Med Care 30:473–483

    Article  Google Scholar 

  22. Wenger A, Englund M, Wirth W, Hudelmaier M, Kwoh K, Eckstein F (2012) Relationship of 3D meniscal morphology and position with knee pain in subjects with knee osteoarthritis: a pilot study. Eur Radiol 22:211–220

    Article  Google Scholar 

  23. Willinger L, Lang JJ, von Deimling C, Diermeier T, Petersen W, Imhoff AB et al (2020) Varus alignment increases medial meniscus extrusion and peak contact pressure: a biomechanical study. Knee Surg Sports Traumatol Arthrosc 28:1092–1098

    Article  Google Scholar 

  24. Yang HY, Kwak WK, Lee CH, Kang JK, Song EK, Seon JK (2022) Extent of preoperative medial meniscal extrusion influences intermediate-term outcomes after medial opening-wedge high tibial osteotomy. J Bone Jt Surg Am 104:316–325

    Article  Google Scholar 

Download references

Acknowledgements

No specific grant was received for this research from funding agencies in the public, commercial, or not-for-profit-sectors.

Funding

The authors declare that there they have non-financial competing interests.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, 322 Seoyang-ro, Hwasun-gun, 58128, Republic of Korea

    Chang-Hyun Lee, Hong-Yeol Yang & Jong-Keun Seon

Authors
  1. Chang-Hyun Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hong-Yeol Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jong-Keun Seon
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All the authors contributed to the study conception and design. Material preparation, and data collection and analysis were performed by C-HL, H-YY, and J-KS. Review, editing, and supervision by J-KS.

Corresponding author

Correspondence to Jong-Keun Seon.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of Hwasun Chonnam National University Hospital approved this study.

Informed consent

Informed consent was not required for this type of study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Lee, CH., Yang, HY. & Seon, JK. Increased medial meniscus extrusion led to worse clinical outcomes after medial opening-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc (2022). https://doi.org/10.1007/s00167-022-07148-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00167-022-07148-3

Keywords

  • Clinical outcomes
  • High tibial osteotomy
  • Knee osteoarthritis
  • Medial opening-wedge
  • Meniscal extrusion