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; I2 = 0%; p < 0.01) and IKDC scores (SMD: 0.31; 95% CI 0.01-0.61; I2 = 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.