Summary

Osteotomy is good treatment option for degenerative medial meniscal tear

Abstract

Introduction

Meniscus repair in the aged shows less favorable results. As a result, treating degenerative meniscal lesions with arthroscopic menisectomy to in the middle-aged and elderly is still common. The precise mechanism of degenerative tearing isn’t understood. However, a symptomatic degenerative meniscal lesion points to an osteoarthritic knee or at least to an elevated risk of osteoarthritis. It is reported that mechanical symptoms of degenerative medial meniscus tear are rare, and it’s common for knee pain to be associated with osteoarthritis. In MRI study showed that intramedullary change or thinning of cartilage were often observed with degenerative medial meniscal tear.
Materials and methods:(1)We investigate a meniscal treatment criteria score, Japanese Orthopedic Association Score and range of motion of eight knees (group A) who required HTO in two periods after a partial meniscal resection for a six-month period, and five knees (group B) who underwent a partial meniscal resection and HTO in one term (52 years old). (2) We evaluated 10 knees that underwent an only HTO and 4 knees that underwent MS+HTO. The average age was 65 years old. We compared the T2 values of the range of interests (ROI) in 6 locations by T2 mapping coronal imaging using 3T MRI between pre-operation and 1 year post-operation.

Results

(1)The results showed that in group A, the pain in walking and stair climbing deteriorated after the partial meniscal resection, and it improved after HTO operation. All items in group B improved after the operation. (2) WORMS for cartilage and BLOKS for medial meniscus lesions were used. Postoperative T2 values were statistically less (P<0.05) in the only medial mid femoral location in HTO compared with pre-operation. There were no statistical changes of T2 values in MS+HTO between pre-operation and post-operation. Medial meniscal extrusion did not improve in both groups.

Discussion

In clinical study, HTO was effective in preventing the progression of pain after a partial meniscal resection. In MRI study, we found statistical improvement of cartilage in medial mid femur only after HTO, not meniscectomy combined with HTO.
These results showed that osteotomy is good treatment option for degenerative medial meniscal tear. Theoretically and hopefully HTO would reduce mechanical stress. It is reported that meniscal stress reduce 1MP after open wedged high tibia osteotomy. We didn’t know that a relationship of meniscal repair and knee degeneration. It is reported that short term results after meniscal repair using scaffold combined HTO is not superior a partial meniscal resection combined HTO. Also meniscal allograft combined HTO is not superior only HTO. HTO is a desirable option for symptomatic degenerative meniscal lesions associated with osteoarthritis.