Impact of Preoperative Medial Meniscus Extrusion and Subchondral Bone Marrow Edema on Postoperative Outcomes Following Medial Opening Wedge High Tibial Osteotomy

Dr. Bighnesh Dash, Dr Aurobindo Das

Abstract: Objective: Currently, limited evidence exists regarding the impact of preoperative medial meniscus extrusion (MME) and subchondral bone marrow edema (BME) on clinical outcomes following medial opening wedge high tibial osteotomy (MOWHTO). This study aimed to evaluate how preoperative MME and BME affect short-term postoperative outcomes in patients undergoing MOWHTO. Methods: A total of 43 patients who underwent MOWHTO between January 2022 and January 2023 were included in this retrospective analysis, with a mean follow-up duration of 1.8 years. Patients were grouped based on MME, classified as pathologic if ? 3 mm. Subchondral BME was graded into four categories using lesion volume criteria from the MRI Osteoarthritis Knee Score (MOAKS). Clinical outcomes were assessed using the Hospital for Special Surgery (HSS) score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Knee Society Score (KSS). Results: The average preoperative MME across all participants was 3.6 ? 1.9 mm. Pathologic MME was observed in 29 patients (67.4%). A positive correlation was found between the severity of BME and the degree of MME. Patients with pathologic MME exhibited significantly poorer clinical outcomes based on WOMAC and KSS pain and function subscales, as well as HSS scores at both 1 and 2 years postoperatively (all p < 0.05). Subchondral BME was present in 35 patients (81.4%). Based on MOAKS grading, the distribution was as follows: 8 patients (18.6%) with grade 0, 17 (39.5%) with grade 1, 11 (25.6%) with grade 2, and 7 (16.3%) with grade 3. Preoperative clinical scores varied significantly across BME grades (p < 0.001), but these differences did not persist at 1 or 2 years post-surgery (p > 0.05). In both univariate and multivariate analyses, only MME showed a consistent association with worse clinical outcomes (p < 0.001). Conclusions: Preoperative MME ? 3 mm is associated with poorer short-term functional and pain-related outcomes following MOWHTO. In contrast, the severity of subchondral BME prior to surgery did not significantly impact postoperative recovery.

Keywords: Medial meniscus extrusion, Subchondral bone marrow edema, High tibial osteotomy

How to Cite?: Dr. Bighnesh Dash, Dr Aurobindo Das, "Impact of Preoperative Medial Meniscus Extrusion and Subchondral Bone Marrow Edema on Postoperative Outcomes Following Medial Opening Wedge High Tibial Osteotomy", Volume 14 Issue 5, May 2025, International Journal of Science and Research (IJSR), Pages: 590-598, https://www.ijsr.net/getabstract.php?paperid=SR25506231509, DOI: https://dx.doi.org/10.21275/SR25506231509