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Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-01-2015 | Knee

Accelerated degeneration of the discoid lateral meniscus after medial opening wedge high tibial osteotomy

Authors: Sae Kwang Kwon, Hong-Kyo Moon, Chul-Jun Choi, Seong-Ho Park, Jae-Jung Lee, Yong-Chan Kim, Young-Sik Park, Yong-Gon Koh

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 1/2015

Abstract

Purpose

This study was undertaken to report clinical outcomes after high tibial osteotomy (HTO) in patients with a discoid lateral meniscus and to determine (1) whether discoid lateral meniscus degeneration by magnetic resonance imaging (MRI) progresses after HTO and (2) whether this progression adversely affects clinical results.

Methods

The records of 292 patients (292 knees) who underwent medial opening HTO were retrospectively reviewed, and discoid types and grades of lateral meniscus degeneration as determined by MRI were recorded preoperatively. Of the 292 patients, 17 (5.8 %) had a discoid lateral meniscus, and postoperative MR images were obtained at least 2 years after HTO for 15 of these 17 patients.

Results

American Knee Society (AKS) pain, knee and function scores significantly improved in the 15 patients after surgery (p < 0.001). Eight (53 %) had an incomplete and 7 (47 %) had a complete discoid lateral meniscus. By preoperative MRI, the distribution of meniscal degeneration was as follows: grade 1, 4 patients; grade 2, 7 patients; and grade 3, 4 patients. At the final follow-up, the distribution of degeneration was as follows: grade 1, 2 patients; grade 2, 5 patients; and grade 3, 8 patients. Two patients with grade 3 degeneration who did not undergo partial meniscectomy showed tear progression. Thus, 8 of the 15 patients (53 %) experienced progressive discoid meniscal degeneration after HTO. Median AKS pain score was significantly lower in the progression group than in the non-progression group (40 vs 45, respectively).

Conclusion

The results of this study suggest that increased load on the lateral compartment after HTO can accelerate discoid lateral meniscus degeneration by MRI and caution that when a discoid lateral meniscus is found by preoperative MRI, progressive degeneration may occur after HTO and clinical outcome may be adversely affected.

Level of evidence

Therapeutic study, Level IV.

Akamatsu Y, Mitsugi N, Mochida Y, Taki N, Kobayashi H, Takeuchi R, Saito T (2012) Navigated opening wedge high tibial osteotomy improves intraoperative correction angle compared with conventional method. Knee Surg Sports Traumatol Arthrosc 20:586–593PubMedCrossRef

Akizuki S, Shibakawa A, Takizawa T, Yamazaki I, Horiuchi H (2008) The long-term outcome of high tibial osteotomy: a ten- to 20-year follow-up. J Bone Joint Surg Br 90:592–596PubMedCrossRef

Amendola A, Bonasia DE (2010) Results of high tibial osteotomy: review of the literature. Int Orthop 34:155–160PubMedCentralPubMedCrossRef

Atay OA, Doral MN, Leblebicioğlu G, Tetik O, Aydingz U (2003) Management of discoid lateral meniscus tears: observations in 34 knees. Arthroscopy 19:346–352PubMedCrossRef

Berman AT, Bosacco SJ, Kirshner S, Avolio A Jr (1991) Factors influencing long-term results in high tibial osteotomy. Clin Orthop Relat Res 272:192–198PubMed

Bonasia DE, Amendola A (2010) Combined medial meniscal transplantation and high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 18:870–873PubMedCrossRef

Brinkman JM, Lobenhoffer P, Agneskirchner JD, Staubli AE, Wymenga AB, van Heerwaarden RJ (2008) Osteotomies around the knee: patient selection, stability of fixation and bone healing in high tibial osteotomies. J Bone Joint Surg Br 90:1548–1557PubMedCrossRef

Clark CR, Ogden JA (1983) Development of the menisci of the human knee joint. Morphological changes and their potential role in childhood meniscal injury. J Bone Joint Surg Am 65:538–547PubMed

Ding J, Zhao J, He Y, Huangfu X, Zeng B (2009) Risk factors for articular cartilage lesions in symptomatic discoid lateral meniscus. Arthroscopy 25:1423–1426PubMedCrossRef

10.

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

11.

Flecher X, Parratte S, Aubaniac JM, Argenson JN (2006) A 12–28-year followup study of closing wedge high tibial osteotomy. Clin Orthop Relat Res 452:91–96PubMedCrossRef

12.

Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P (2012) Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-012-2087-2 PubMed

13.

Fukuta S, Masaki K, Korai F (2002) Prevalence of abnormal findings in magnetic resonance images of asymptomatic knees. J Orthop Sci 7:287–291PubMedCrossRef

14.

Hernigou P, Medevielle D, Debeyre J, Goutallier D (1987) Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study. J Bone Joint Surg Am 69:332–354PubMed

15.

Insall JN, Joseph DM, Msika C (1984) High tibial osteotomy for varus gonarthrosis. A long-term follow-up study. J Bone Joint Surg Am 66:1040–1048PubMed

16.

Kato Y, Oshida M, Aizawa S, Saito A, Ryu J (2004) Discoid lateral menisci in Japanese cadaver knees. Mod Rheumatol 14:154–159PubMedCrossRef

17.

Kim S, Koh Y, Chun Y, Kim Y, Park Y, Sung C (2009) Medial opening wedge high-tibial osteotomy using a kinematic navigation system versus a conventional method: a 1-year retrospective, comparative study. Knee Surg Sports Traumatol Arthrosc 17:128–134PubMedCrossRef

18.

Kocher MS, Klingele K, Rassman SO (2003) Meniscal disorders: normal, discoid, and cysts. Orthop Clin North Am 34:329–340PubMedCrossRef

19.

Koshino T, Wada S, Ara Y, Saito T (2003) Regeneration of degenerated articular cartilage after high tibial valgus osteotomy for medial compartmental osteoarthritis of the knee. Knee 10:229–236PubMedCrossRef

20.

Koshino T, Yoshida T, Ara Y, Saito I, Saito T (2004) Fifteen to twenty-eight years’ follow-up results of high tibial valgus osteotomy for osteoarthritic knee. Knee 11:439–444PubMedCrossRef

21.

Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174PubMedCrossRef

22.

Madry H, Ziegler R, Orth P, Goebel L, Ong MF, Kohn D, Cucchiarini M, Pape D (2012) Effect of open wedge high tibial osteotomy on the lateral compartment in sheep. Part I: analysis of the lateral meniscus. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-012-2176-2 PubMedCentral

23.

McKellop HA, Sigholm G, Redfern FC, Doyle B, Sarmiento A, Luck JV Sr (1991) The effect of simulated fracture-angulations of the tibia on cartilage pressures in the knee joint. J Bone Joint Surg Am 73:1382–1391PubMed

24.

Noble J (1977) Lesions of the menisci. Autopsy incidence in adults less than fifty-five years old. J Bone Joint Surg Am 59:480–483PubMed

25.

Papachristou G, Plessas S, Sourlas J, Levidiotis C, Chronopoulos E, Papachristou C (2006) Deterioration of long-term results following high tibial osteotomy in patients under 60 years of age. Int Orthop 30:403–408PubMedCentralPubMedCrossRef

26.

Papadopoulos A, Karathanasis A, Kirkos JM, Kapetanos GA (2009) Epidemiologic, clinical and arthroscopic study of the discoid meniscus variant in Greek population. Knee Surg Sports Traumatol Arthrosc 17:600–606PubMedCrossRef

27.

Parker DA, Viskontas DG (2007) Osteotomy for the early varus arthritic knee. Sports Med Arthrosc 15:3–14PubMedCrossRef

28.

Poignard A, Flouzat Lachaniette CH, Amzallag J, Hernigou P (2010) Revisiting high tibial osteotomy: fifty years of experience with the opening-wedge technique. J Bone Joint Surg Am 92(Suppl 2):187–195PubMedCrossRef

29.

Ryu KN, Kim IS, Kim EJ, Ahn JW, Bae DK, Sartoris DJ, Resnick D (1998) MR imaging of tears of discoid lateral menisci. Am J Roentgenol 171:963–967CrossRef

30.

Sprenger TR, Doerzbacher JF (2003) Tibial osteotomy for the treatment of varus gonarthrosis. Survival and failure analysis to twenty-two years. J Bone Joint Surg Am 85-A:469–474PubMed

31.

Staubli AE, Jacob HA (2010) Evolution of open-wedge high-tibial osteotomy: experience with a special angular stable device for internal fixation without interposition material. Int Orthop 34:167–172PubMedCentralPubMedCrossRef

32.

Sterett WI, Steadman JR (2004) Chondral resurfacing and high tibial osteotomy in the varus knee. Am J Sports Med 32:1243–1249PubMedCrossRef

33.

Stoller DW (2007) Magnetic resonance imaging in orthopaedics and sports medicine, 3rd edn. Lippincott Williams & Wilkins, Philadelphia, pp 382–392

34.

Stoller DW, Martin C, Crues JV 3rd, Kaplan L, Mink JH (1987) Meniscal tears: pathologic correlation with MR imaging. Radiology 163:731–735PubMedCrossRef

35.

Takeuchi R, Ishikawa H, Kumagai K, Yamaguchi Y, Chiba N, Akamatsu Y, Saito T (2012) Fractures around the lateral cortical hinge after a medial opening-wedge high tibial osteotomy: a new classification of lateral hinge fracture. Arthroscopy 28:85–94PubMedCrossRef

36.

Tang WC, Henderson IJ (2005) High tibial osteotomy: long term survival analysis and patients’ perspective. Knee 12:410–413PubMedCrossRef

37.

Watanabe M, Takeda S, Ikeuchi H (1978) Atlas of arthroscopy, 3rd edn. Igaku Shoin, Tokyo, p 88

Title: Accelerated degeneration of the discoid lateral meniscus after medial opening wedge high tibial osteotomy
Authors: Sae Kwang Kwon
Hong-Kyo Moon
Chul-Jun Choi
Seong-Ho Park
Jae-Jung Lee
Yong-Chan Kim
Young-Sik Park
Yong-Gon Koh
Publication date: 01-01-2015
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 1/2015
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-012-2289-7

At a glance: The STEP trials

Springer Medicine

Accelerated degeneration of the discoid lateral meniscus after medial opening wedge high tibial osteotomy

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

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