Abstract
Objectives:
The purpose of this study was to compare the survival rates and clinical outcomes of patients who received medial MAT+HTO (MAT+HTO group) with a control group undergoing isolated medial MAT (MAT group), to define if a surgically corrected varus malignment may affect patient’s outcomes and the survivorship of MAT over time. The hypothesis was that there is no difference between the two groups and, therefore, a concomitant realignment procedure can be a valid treatment to restore the limb axis.
Methods:
A total of 110 patients underwent arthroscopic MAT with soft tissue technique: 55 underwent medial MAT and HTO (age 41.3 ± 10.4; 9 females) and 55 controls receiving isolated medial MAT were included after fuzzy case-control matching on demographics. Survival analysis was performed using the Kaplan–Meier curve with surgical failure, clinical failure (Lysholm score<65), and reoperations as endpoints. Subjective clinical scores (Lysholm, Tegner Activity Scale, KOOS, and VAS) were collected preoperatively and at final follow-up.
Results:
The mean follow-up time was 5.4 ± 3.4 years (up to 8 years). All outcomes significantly improved at the last follow-up (p<0.001). No differences were identified between MAT and MAT + HTO groups preoperatively and at the last follow-up (p>0.05). At final follow-up, 8/55 (14.5%) of the MAT+HTO patients and 9/55 (16.4%) of the MAT patients had a Lysholm <65 (p>0.05). Overall, 90% of the patients declared they would repeat the surgery regardless of the combined procedure. Surgical failure was identified in 6/110 patients (5.5%): 5/55 (9.1%) in the MAT+HTO group and 1/55 (1.8%) in the MAT group (p>0.05). Clinical failure was identified in 19/110 patients (17.3%): 11/55 (20%) in the MAT+HTO group and 8/55 (14.5%) in the MAT group (p>0.05). A significantly lower survivorship from surgical failure was identified in the MAT + HTO group (Hazard Ratio=5.1, p=0.049), while no differences in survivorship from reoperation and clinical failure were identified (p>0.05).
Conclusions:
Patients with varus malalignment and medial meniscus deficiency who are treated with combined medial MAT and HTO showed satisfactory clinical results at a mid-term follow-up, and thus malalignment represents only a relative contraindication for MAT.