Combined Procedure of Arthroscopic Pullout Medial Meniscal Root Repair From Lateral Tibia and Open-Wedge Distal Tibial Tubercle Osteotomy

Pullout repair of medial meniscal posterior root tears (MMPRTs) is generally recommended for patients with well-aligned knees, whereas open-wedge high tibial osteotomy (OWHTO) is often recommended for patients with MMPRTs and varus osteoarthritis. Although the management of MMPRTs with OWHTO has been controversial, retaining meniscal function can be expected through pullout repair. Conventionally, bone tunnels in pullout repair are created from the proximal anteromedial tibia. However, this technique could cause a killer angle of the repaired meniscus and could have a risk of turning the guidewire toward the neurovascular band. Therefore, we create a bone tunnel from the proximal anterolateral tibia combined with open-wedge distal tibial tubercle osteotomy, which can prevent an increase in postoperative patellofemoral contact stress; moreover, the bone tunnel can be created easily from the lateral tibia compared with OWHTO. This Technical Note describes the combined surgical procedure for patients with MMPRTs and varus osteoarthritis, which has advantages including physiological pullout direction of the repaired meniscus, lower risk of neurovascular damage, and placement of a longer plate screw that could interfere with the bone tunnel. We highlight the meticulous consideration given to the interference of the bone tunnel between the osteotomy line and plate screw.