Personalized approach to the treatment of patients with medial meniscus tear combined with varus deformity of the tibia

Abstract

Introduction Meniscus tear is one of the most common injuries of the knee joint. Medial meniscus tear accounts for 23–31 % of knee joint injuries. The main method of treatment is partial resection. As reported, 13.5 % of patients undergo arthroplasty within 15 years after meniscus resection, what is regarded as an unsatisfactory result. Purpose To evaluate and compare the long-term clinical, functional and radiological results of surgical treatment in patients with medial meniscus tear combined with varus deformity of the tibia and without it. Materials and methods From 2013 to 2020, medial meniscus tear was treated in 245 patients. The patients were divided into 4 groups. Group 1 included patients with a mechanical femorotibial angle (MFTА) from 0º to 3º who had arthroscopic meniscus resection (AMR). In the 2nd group, all patients also underwent AMR, but their MFTА was more than 3º. In group 3, patients with MFTА from 3º to 5º underwent simultaneous AMR and proximal fibular osteotomy (PFO) with the formation of a defect. Group 4 included patients with MFTА more than 5º, who underwent high tibial osteotomy (HTO) and AMR. Changes in the main lines and angles were assessed with telemetry radiography of the lower extremities. Functional results were evaluated before and after surgery using the Lysholm Knee Scoring Scale, 2000 IKDC, KOOS. Results Isolated meniscus resection in patients with MFTА more than 3º without axial correction leads to a gradual increase in the deformity by 1,070 ± 0.50º during the first year after surgery, and by 2.20 ± 0.70º to the fifth year. In groups 1, 3 and 4, there was no statistically significant increase in MFTА during the entire observation period. The clinical treatment results of patients of the four groups in the first three years after surgery did not differ statistically. However, within the period from 3 to 5 years, patients with MFTА greater than 3º who underwent only AMR had poorer clinical results than in the other groups (p < 0.001). Conclusions A personalized approach to the method of surgical treatment for medial meniscus tear based on the MFTА enables to correct the mechanical axis of the lower extremities and MFTА, and thus improve the long-term clinical, functional and radiological results of surgical treatment.

Keywords

• meniscus tear
• varus tibial deformity
• high tibial osteotomy
• proximal fibular osteotomy