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Identical clinical outcomes between neutral and classic targeted alignments after high tibial osteotomy in medial meniscus posterior root tear: a prospective randomized study

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Abstract

Purpose

This study aimed to compare the clinical and radiographic outcomes and arthroscopic findings after high tibial osteotomy (HTO) between neutral and classic targeted coronal alignments in patients with medial meniscus posterior root tears (MMPRTs).

Methods

Ninety-eight patients with MMPRT were prospectively enrolled in the final cohort and randomized into two groups. Fifty-two patients with the targeted alignment through the Fujisawa point (60–62.5% of the entire tibial plateau width measured from the medial side) during HTO were included in group A, whereas 46 patients with the targeted alignment through the point at 50–55% of the tibial plateau width were included in group B. The clinical and radiographic outcomes and second-look arthroscopic findings were statistically compared for comprehensive assessments.

Results

After a mean follow-up of 37.1 months, we found no significant differences between the two groups regarding the final Lysholm (p = 0.205) and Hospital for Special Surgery scores (p = 0.084). However, we only observed significant differences between the two groups in terms of the final hip–knee–ankle angle, weight-bearing line ratio, and medial proximal tibial angle (p < 0.001). Second-look arthroscopy did not reveal a significant difference in meniscal healing rate (p = 0.786).

Conclusions

Performing HTO with the aim to achieve neutral alignment leads to similar clinical outcomes in patients with MMPRT compared to classic alignment. Although subsequent research is required, the current study provides clinical evidence for the safety and efficacy of the new targeted alignment during HTO, which may avoid long-term complications associated with overcorrection when using the traditional technique.

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Data Availability

Data available on request due to restrictions, e.g., privacy or ethical. The data presented in this study are available on request from the corresponding author.

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Funding

This research was supported by Zhejiang Provincial Natural Science Foundation of China under Grant No. LBY21H060001.

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Author notes

  1. Lan Lin and Songli Jiang contributed equally to the work.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Shangcai Village, Ouhai District, Wenzhou, 325000, China

    Lan Lin, Songli Jiang, Shengwu Yang & Lei Zhang

  2. Department of Adult Reconstruction, The Third Affiliated Hospital of Wenzhou Medical University, No.108, Wansong Road, Ruian, Wenzhou, 325200, China

    Guojing Yang, Bingju Xie & Lei Zhang

Authors
  1. Lan Lin
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  2. Songli Jiang
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Contributions

Conceptualization: Lei Zhang. Methodology: Lan Lin and Songli Jiang. Formal analysis and investigation: Shengwu Yang. Writing–original draft preparation: Lan Lin. Writing–review and editing: Bingju Xie and Lei Zhang. Supervision: Guojing Yang.

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Correspondence to Shengwu Yang, Bingju Xie or Lei Zhang.

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This retrospective 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 the hospital approved this study.

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Level of evidence: II, prospective comparative study.

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Lin, L., Jiang, S., Yang, S. et al. Identical clinical outcomes between neutral and classic targeted alignments after high tibial osteotomy in medial meniscus posterior root tear: a prospective randomized study. International Orthopaedics (SICOT) 48, 427–437 (2024). https://doi.org/10.1007/s00264-023-05960-1

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