Arthroscopic All-in Technique Combined with High Tibial Osteotomy for Osteoarthritis with Posterior Root Tear of the Medial Meniscus

Arthroscopic All-in Technique Combined with High Tibial Osteotomy for Osteoarthritis with Posterior Root Tear of the Medial Meniscus | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Arthroscopic All-in Technique Combined with High Tibial Osteotomy for Osteoarthritis with Posterior Root Tear of the Medial Meniscus Xinda Zhang, Yi Zheng, Yingzhen Niu, Conglei Dong, Zhuangdai Zhang, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7840788/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 07 Feb, 2026 Read the published version in Journal of Orthopaedic Surgery and Research → Version 1 posted 10 You are reading this latest preprint version Abstract Background Medial Meniscus Posterior Root Tears (MMPRTs) are known to accelerate medial compartment knee osteoarthritis (OA). This study aimed to evaluate the short-term clinical outcomes of arthroscopic all-suture anchor (ASA) repair combined with high tibial osteotomy (HTO) for patients with medial compartment OA and MMPRTs, offering a potential new surgical approach for this condition. Methods This study retrospectively reviewed patients undergoing arthroscopic ASA repair combined with HTO for medial compartment OA with MMPRTs at our institution between June 2022 and June 2023. All patients underwent second-look arthroscopy during hardware removal. We collected demographic data (age, sex, affected side, duration of symptoms, complications), preoperative and postoperative Tegner activity scores, Lysholm scores, International Knee Documentation Committee (IKDC) scores, and Knee injury and Osteoarthritis Outcome Scores (KOOS). Radiographic comparisons (pre- and post-op) included Kellgren-Lawrence (K-L) grading, hip-knee-ankle angle (HKA), medial proximal tibial angle (mPTA), joint line convergence angle (JLCA), and posterior tibial slope (PTS). Medial meniscus extrusion rate (MMER) was also assessed. At second-look arthroscopy, the healing status of the medial meniscus posterior root was evaluated. Patients were subgrouped based on root healing status to examine correlations with clinical scores, MMER, K-L grade, and symptom duration. Results The cohort comprised 30 females (83.3%) and 6 males (16.7%), with a mean age of 59 years. Mean follow-up was 24.8 ± 2.4 months. Significant improvements were observed in all final scores: Lysholm (46.58 ± 16.04 to 79.08 ± 14.29), IKDC (37.08 ± 14.57 to 65.81 ± 12.33), KOOS (116.50 ± 26.13 to 65.89 ± 15.50), and Tegner (1.00 ± 1.27 to 2.33 ± 1.15) (all P < 0.001). Subgroup analysis revealed no significant differences between healed and non-healed groups regarding Lysholm, IKDC, KOOS, Tegner scores, symptom duration, or K-L grade. No complications (infection, nonunion, neurovascular issues) occurred by final follow-up. Conclusion Arthroscopic ASA repair combined with HTO significantly improves short-term clinical outcomes in patients with medial compartment OA and MMPRTs. Crucially, the healing status of the medial meniscus posterior root showed no correlation with these short-term clinical outcomes and did not influence the clinical presentation after HTO. Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Medial Meniscus Posterior Root Tears (MMPRTs) have gained significant clinical attention in recent years due to their unique location. Defined as radial tears within 1 cm of the bony attachment or avulsion injuries at the tibial insertion, MMPRTs account for approximately 10%-21% of all meniscal surgeries 1 , 2 . Biomechanically, MMPRTs disrupt hoop tension, leading to pathological medial meniscus extrusion, increased medial compartment contact pressure (comparable to total meniscectomy), and ultimately accelerated osteoarthritis (OA) progression 3 . Evidence suggests MMPRTs repair yields better clinical outcomes than partial meniscectomy, with one long-term (10-year) follow-up reporting lower rates of subsequent total knee arthroplasty (TKA) after repair versus resection 4 . Therefore, repairing MMPRTs is critical for restoring hoop tension, distributing stress, and preventing OA progression 5 . Varus limb alignment is a significant risk factor for both MMPRTs and meniscal extrusion, with varus > 5° considered a poor prognostic factor for repair success 6 . High tibial osteotomy (HTO) for medial compartment OA with varus alignment has been shown to slow OA progression 7 . Consequently, combining HTO with MMPRTs repair represents a logical treatment strategy, with prior studies reporting good outcomes using pullout repair techniques alongside HTO 8 , 9 . However, traditional pullout techniques can be complicated by suture interference with HTO plates/screws, the "bungee effect," suture wear, and creep 9 , 10 . To address these issues, we propose the innovative use of all-suture anchor (ASA) for MMPRTs repair in conjunction with HTO. Recent biomechanical studies support the effectiveness of ASA for medial meniscus posterior root repair 11 , but no clinical studies have evaluated ASA repair combined with HTO for MMPRTs with medial compartment OA. This study aims to assess the clinical scores, radiological outcomes, and second-look arthroscopic findings following arthroscopic ASA repair combined with HTO for MMPRTs with medial compartment OA. We hypothesize that this combined approach can repair the posterior root of the medial meniscus, significantly enhances patient outcomes, and delays OA progression. Materials and Methods 1. Clinical Data 1.1 Study Population This retrospective study analyzed patients with medial compartment osteoarthritis (OA) and medial meniscus posterior rotator tears (MMPRTs) who underwent arthroscopic ASA suturing of MMPRTs combined with high tibial osteotomy (HTO) at our hospital between June 2022 and June 2023. All patients underwent arthroscopic second-look exploration during secondary surgery to remove internal fixation devices. After screening, 43 patients met the inclusion criteria. Among these, 7 patients were lost to follow-up, resulting in a final cohort of 36 patients. Senior surgeons performed all procedures. Ethical approval was obtained (IRB No. 2024-092-1). 1.2 Inclusion Criteria Laprade type 2 MMPRTs confirmed on Magnetic Resonance Imaging(MRI)(ghost sign, truncation sign). Medial compartment OA, K-L grade II-III. Medial proximal tibial angle (mPTA) < 85°. Age 40–65 years. Medial tibiofemoral cartilage Outerbridge grade ≤ 3. Laprade classfication: Type I is an isolated, stable partial tear at the root of the meniscus. Type 2 is a complete radial tear at the root of the meniscus. Type 3 is a tear with a concomitant longitudinal/circumferential tear (commonly referred to as a “bucket handle” tear). Type 4 involves an oblique meniscus tear extending to the meniscus root, resulting in complete root avulsion. Type 5 describes a complete avulsion fracture at the base of the tibial plateau attachment site. 1.3Exclusion Criteria Requirement for concurrent ligament reconstruction or other major soft tissue procedures. Previous knee surgery on the affected side. Failed primary MMPRTs repair. Incomplete medical records or loss to follow-up. 1.4 General Data Collected data included sex, age, BMI, affected side, and postoperative complications. 2. Surgical Technique Patients were positioned supine. Following standard sterilization and draping, standard anteromedial (AM) and anterolateral (AL) arthroscopic portals were established. The knee was examined under gentle valgus stress, maintained between 0–30° flexion. Intra-articular structures (menisci, ACL, PCL, cartilage) were assessed. The medial meniscus posterior root was visualized via the AL portal. If access to the medial compartment was tight, pie-crusting release of the posterior oblique fibers of the superficial medial collateral ligament (sMCL) was performed to confirm the MMPRTs. The root remnant and tibial footprint were debrided and freshened using a shaver and curette. A 2.4mm guide pin was drilled through a tibial guide targeting the anatomical root footprint. An epidural needle loaded with No. 1 PDS suture was passed through the tibial tunnel into the joint, and a suture retriever pulled the PDS out through the AM portal. The knot of the ASA was disengaged from its base and threaded through the PDS loop. Under arthroscopic visualization, the PDS suture was used to pull the ASA knot into the bone tunnel until flush with the cortex (Fig. 1 ). Tensioning the ASA tails deployed the anchor beneath the cortex, and the PDS was removed. The torn root was then sutured approximately 5mm medial to the tear margin using a combination of loop and simple stitches under appropriate tension. Stability was confirmed with a probe (Fig. 2 ). Following arthroscopy, a 7-cm longitudinal incision was made over the proximal medial tibia. After releasing the superior border of the pes anserinus and distal sMCL fibers, Hohmann retractors were placed to protect posterior neurovascular structures. A Kirschner wire was drilled 35mm distal to the medial joint line, directed towards the fibular head, ending 5mm short of the lateral cortex. Fluoroscopy confirmed correct position before performing the osteotomy along the wire, carefully avoiding posterior structures. A second biplanar osteotomy cut was made ≥ 10mm proximal to the first cut, starting at the patellar tendon insertion and angled at 110°. The osteotomy gap was opened according to the preoperatively calculated correction angle and intraoperative cartilage status (Outerbridge grade): the mechanical axis was aimed at 50–55% of the medial tibial plateau width for Outerbridge grade 1–2 cartilage damage, and at Fujisawa's point for Outerbridge grade 3 damage. An osteotomy plate was fixed medially. The joint was irrigated, a drain placed, and the wound closed in layers. 3.Postoperative Rehabilitation Quadriceps isometrics and straight leg raises began immediately postoperatively. Touch-down weight-bearing with crutches was permitted. Knee flexion was limited to < 90° for the first 4 weeks. Partial weight-bearing commenced at 4–6 weeks, progressing to full weight-bearing by 6 weeks. Deep squatting was avoided for 3 months. 4.Outcome Assessment Two authors measured the preoperative and postoperative data, and the consistency analysis was performed.To test the reliability of the measurements,two authors measured all of the images independently. One of the two authors repeated the measurements 2 weeks later.Clinical assessment utilized the Tegner activity score, Lysholm score, IKDC score, and KOOS preoperatively and at final follow-up.Standing full-length weight-bearing radiographs obtained preoperatively and at hardware removal were used to assess K-L grade, HKA, mPTA, JLCA, and PTS. Preoperative and post-hardware removal MRI (1.5-T Achieva, Philips) assessed MMER. MMER (%) was calculated as: (Extruded meniscus width / Total meniscus width) x 100. Measurements were taken on three consecutive slices at the MCL level and averaged (Fig. 3 ). All patients underwent second-look arthroscopy during hardware removal. Root healing status was categorized as: Complete Healing: No tear, good synovial coverage, stable on probing. Partial Healing: Continuity present but reduced tension on probing. Failure: No continuity, no tension, no evidence of healing. Statistical Analysis SPSS version 24.0 was used. Continuous data are presented as mean ± standard deviation (SD). Paired t-tests compared pre- and postoperative scores and imaging parameters. For subgroup analysis, Complete and Partial Healing were combined into a "Healed" group and compared to the "Failure" group using independent t-tests or Mann-Whitney U tests as appropriate. P < 0.05 was considered statistically significant.The interobserver and intraobserver reliabilities for measurements were verified by the intraclass correlation coefficient (ICC). ICC values between 0.8 and 0.9 were considered good. Results The study finally enrolled 36 patients: 30 females (83.3%) and 6 males (16.7%), mean age 58.92 ± 5.12 years. There were 21 right knees and 15 left knees. Mean follow-up duration was 24.8 ± 2.4 months. No complications (infection, nonunion, neurovascular issues) occurred by final follow-up. Patient demographic data are presented in Table 1 . Table 1 Patient demographics and posterior root healing status Age Sex Pain Duration (mo) Side FU (mo) Healing Status 1 65 F 120 R 12 Complete Healing 2 65 F 1 R 12 Partial Healing 3 53 M 6 L 12 Failure 4 65 F 48 L 12 Failure 5 58 F 120 R 12 Partial Healing 6 52 F 3 L 12 Partial Healing 7 54 M 3 L 12 Complete Healing 8 54 M 12 R 12 Failure 9 65 F 6 R 12 Failure 10 52 F 24 R 12 Partial Healing 11 65 F 36 L 9 Failure 12 54 F 4 R 17 Partial Healing 13 65 F 36 R 18 Failure 14 61 F 3 R 11 Complete Healing 15 59 F 2 L 11 Failure 16 57 F 1 R 12 Partial Healing 17 56 F 10 R 12 Failure 18 62 F 4 L 15 Partial Healing 19 59 F 1 L 13 Complete Healing 20 49 F 12 R 12 Complete Healing 21 57 M 12 R 13 Failure 22 57 F 36 L 12 Complete Healing 23 65 F 6 L 17 Failure 24 65 F 5 L 14 Failure 25 58 F 36 L 15 Failure 26 64 F 4 R 14 Complete Healing 27 49 F 6 R 17 Failure 28 64 F 1 L 12 Failure 29 51 F 1 R 12 Failure 30 57 F 2 R 12 Complete Healing 31 62 F 24 R 15 Failure 32 63 F 1 R 14 Complete Healing 33 65 F 36 L 12 Complete Healing 34 58 M 6 R 15 Failure 35 57 F 12 R 14 Partial Healing 36 59 M 3 L 14 Failure Significant improvements were observed in all clinical scores at final follow-up: Lysholm scores improved from 46.58 ± 16.04 to 79.08 ± 14.29, IKDC scores from 37.08 ± 14.57 to 65.81 ± 12.33, KOOS scores decreased (indicating improvement) from 116.50 ± 26.13 to 65.89 ± 15.50, and Tegner activity scores from 1.00 ± 1.27 to 2.33 ± 1.15 (all P < 0.001) (Table 2 ). Subgroup analysis showed no significant differences in postoperative Lysholm, IKDC, KOOS, or Tegner scores, or in K-L grade, between the healed group and the non-healed group (Table 3 ). Table 2 Comparison of preoperative and final follow-up clinical scores and imaging Preop Final FU t-value P-value Tegner 1.00 ± 1.27 2.33 ± 1.15 -7.135 <0.001 IKDC 37.08 ± 14.57 65.81 ± 12.33 -10.589 <0.001 KOOS 116.50 ± 26.13 65.89 ± 15.50 12.009 <0.001 Lysholm 46.58 ± 16.04 79.08 ± 14.29 -11.190 <0.001 MMER(%) 31.61 ± 11.74 32.53 ± 10.33 -0.681 0.500 HKA(°) 173.02 ± 2.43 179.96 ± 2.27 -19.09 <0.001 mPTA(°) 84.96 ± 2.20 90.06 ± 1.92 -15.63 <0.001 JLCA(°) 1.96 ± 1.19 1.93 ± 1.21 0.203 0.840 PTS(°) 9.76 ± 3.24 11.65 ± 3.85 -3.355 0.002 K-L分级 1.83 ± 0.66 1.86 ± 0.64 -3.24 0.661 Tegner: Tegner activity score;IKDC༚International Knee Documentation Committee score༛KOOS:Knee injury and osteoarthristyis outcome score;Lysholm:Lysholm score;MMER:Medial Meniscus Extrusion Rate Table 3 Subgroup analysis of root healing status after semilunar Tegener KOOS IKDC Lysholm MMER(%) K-L Pain duration(mo) Healed Group (n = 18) 2.39 ± 1.04 68.67 ± 16.55 62.50 ± 11.53 77.89 ± 15.39 32.82 ± 8.49 1.94 ± 0.15 21.50 ± 37.59 Failure Group (n = 18) 2.28 ± 1.27 63.11 ± 14.31 69.11 ± 12.53 80.28 ± 13.44 32.23 ± 12.14 1.78 ± 0.15 14.22 ± 14.82 P 0.776 0.289 0.109 0.623 0.868 0.50 0.450 Significant coronal plane correction was achieved, with the HKA improving from a preoperative mean of 173.02 ± 2.43° to 179.96 ± 2.27° at final follow-up. The mean posterior tibial slope (PTS) increased significantly from 9.76 ± 3.24° preoperatively to 11.65 ± 3.85° at final follow-up (P 0.05). On final follow-up MRI, the medial meniscus extrusion rate (MMER) increased in 17 patients (47%) and decreased in 19 patients (53%). The mean MMER increased slightly from 31.61 ± 11.74% to 32.53 ± 10.33%, but this change was not statistically significant (P = 0.5). Second-look arthroscopy findings: 10 patients (28%) demonstrated complete healing (Fig. 4 A), 8 (22%) partial healing, and 18 (50%) failure (Fig. 4 B-C). All patients showed clinical improvement. Subgroup analysis comparing the Healed group (Complete + Partial) to the Failure group revealed no significant differences in postoperative Tegner, IKDC, KOOS, Lysholm scores, MMER, symptom duration, or K-L grade (P > 0.05 for all, Table 3 ). With respect to the intra- and interobserver reliability,excellent agreement was observed for both reliability measures for pre- and postoperative measurements (ICC values ranging from 0.83 to 0.89) .(Table 4 , 5 ) Table 4 Intra observer CCS Pre-op Post-op MMER 0.83 0.86 HKA 0.89 0.88 mPTA 0.84 0.86 PTS 0.87 0.89 Table 5 Inter observer CCS Pre-op Post-op MMER 0.88 0.84 HKA 0.86 0.88 mPTA 0.88 0.84 PTS 0.83 0.84 Discussion The key finding of this study was that arthroscopic ASA repair combined with HTO significantly improved short-term clinical outcomes in patients with MMPRTs and medial compartment OA at a mean follow-up of 24.8 months. Second-look arthroscopy revealed complete healing in 28% and partial healing in 22% of roots. Crucially, the status of root healing showed no correlation with the observed clinical improvements. Significant enhancements in Lysholm, IKDC, KOOS, and Tegner scores demonstrate the efficacy of this combined technique, achieving outcomes comparable to those reported for pullout repair combined with HTO 12 . This is the first clinical report on ASA combined with HTO. ASA repair offers potential advantages over pullout techniques, including avoiding suture-plate/screw interference, the "bungee effect," suture wear, and creep 9 , 10 , and potentially reducing risk to posterior neurovascular structures compared to suture anchor. The tibial tunnel placement also avoids conflict with the HTO site. By reducing medial compartment pressure, HTO may create a more favorable environment for root healing. Biomechanically, ASA have shown superiority to pullout techniques in restoring contact area under load, achieving near-normal tibiofemoral contact mechanics 13 .The relatively short follow-up period of our study may account for this discrepancy. While MMPRTs repair aims to restore function and prevent OA progression, medial meniscus extrusion (MME) remains a key risk factor for OA advancement. Studies on MME correction post-repair show conflicting results 14 , 15 . Our study found no significant overall change in MMER, suggesting root repair alone may not consistently resolve extrusion; factors like surgical technique, rehabilitation protocol, and healing status likely influence MME. Chung et al. 16 reported K-L progression in 68% of patients after pullout repair at short-term follow-up. In contrast, only 8% (3/36) of our cohort showed K-L progression at 2 years, with 86% stable and 6% improved. This suggests the combination of HTO with repair may better delay OA progression, although significant reversal is unlikely. Our second-look healing rates (28% complete, 22% partial, 50% failure) are lower than the 48% complete, 42% partial, and 10% failure reported in a systematic review 17 . We frequently observed suture cut-through as a primary failure cause, potentially due to excessive tension during fixation or premature loading during rehabilitation. Biomechanical studies suggest optimal initial suture tension is around 30N 18 , and weight-bearing or motion exceeding the repair's tolerance can generate damaging forces 19 . The learning curve associated with this technique might also have contributed to suboptimal tunnel placement in some cases. Accurate anatomical tunnel positioning (posterolateral direction) is critical for reducing extrusion and improving healing rates 20 , 21 . Most significantly, subgroup analysis revealed no difference in clinical outcomes between patients with healed versus non-healed roots. This implies that for patients with MMPRTs and varus malalignment, HTO alone may yield good clinical results even if the root fails to heal. The mechanical correction provided by HTO, altering medial compartment pressure and the local microenvironment, appears to be the pivotal factor driving clinical improvement. This finding aligns with several studies reporting comparable outcomes between HTO alone and HTO combined with MMPRTs repair 22 , 23 , 24 , 25 . Nha et al. 24 observed high rates of spontaneous root healing after HTO alone, unrelated to clinical improvement. Ke et al. 26 and Seo et al. 27 found no significant benefit from adding root repair to HTO. Lee et al. 28 concluded there is no clear evidence mandating concurrent MMPRTs repair during HTO. The significant postoperative increase in PTS warrants attention. This likely stems from greater anterior gap opening during medial opening-wedge HTO. Contributing factors include easier surgical access anteriorly, plate placement location (more anterior placement increases PTS) 30 , and greater resistance from posterior soft tissues (sMCL origin) 29 . Increased PTS is a known risk factor for ACL/PCL injury 31 , 32 . Mitigation strategies include placing distractors posteriorly to create a slightly trapezoidal gap and ensuring adequate release of the pes anserinus/sMCL 33 . Limitations This study has limitations inherent to its retrospective design, including potential selection bias. The sample size is relatively small, and the follow-up period is short-term; larger, long-term studies are needed. The learning curve associated with the ASA technique may have affected tunnel placement accuracy and suture tension control, potentially influencing healing rates. Conclusion Arthroscopic ASA repair combined with HTO significantly improves short-term clinical outcomes in patients with medial compartment OA and MMPRTs. Crucially, the healing status of the medial meniscus posterior root showed no correlation with these short-term clinical outcomes and did not influence the clinical presentation after HTO. Declarations Ethical approval and consent to participate This study conforms to the provisions of the Declaration of Helsinki and has been reviewed and approved by the Institutional Review Board (IRB) of the Third Hospital of Hebei Medical University (IRB number: KE 2024-092-1).The patient had given the informed consent to allow their information to be used in research purposes and informed consent was obtained from the participant. Clinical trial number: not applicable. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Funding None Author Contribution J.T.D. carried out and designed the study. X.D.Z., Y.Z., Y.Z.N. analyzed the data. All authors contributed to data collection. Y.Z. and X.D.Z. wrote the manuscript., and J.T.D. approved the final version of the manuscript. All of the authors read and approved the final manuscript. Acknowledgements We sincerely thank the patient in this study. Data Availability All data generated or analysed during this study are included in this published article. References Choi SH. The MRI findings of meniscal root tear of the medial meniscus: emphasis on coronal, sagittal and axial images. Knee Surg Sports Traumatol Arthrosc; 2012. Bhatia S. Meniscal root tears: significance, diagnosis, and treatment. Am J Sports Med. 2014;42(12):3016–30. Berk AN, Cregar WM, Wang S et al. The Effect of Lower Limb Alignment on Tibiofemoral Joint Contact Biomechanics after Medial Meniscus Posterior Root Repair:A Finite-Element Analysis. J Am Acad OrthopSurg.PublishedonlineApril19,2024. Lamba A, Regan C, Levy BA, Stuart MJ, Krych AJ, Hevesi M. Long-term Outcomes of Partial Meniscectomy for Degenerative Medial Meniscus Posterior Root Tears. Orthop J Sports Med. 2024;12(9):23259671241266593. Graham BC, Weiss-Laxer NS, Haider MN, Marzo JM. Item-Specific Knee Injury and Osteoarthritis Outcome Score Characterization of Patients With Medial Meniscus Root Tear. Orthop J Sports Med. 2024;12(4):23259671241241094. Published 2024 Apr 12. Chung KS, Ha JK, Ra HJ, Kim JG. Preoperative varus alignment and postoperative meniscus extrusion are the main long-term predictive factors of clinical failure of meniscal root repair. Knee Surg Sports Traumatol Arthrosc. 2021;29(12):4122–30. Kim YM, Joo YB, Lee WY, Kim YK. Remodified Mason-Allen suture technique concomitant with high tibial osteotomy for medial meniscus posterior root tears improved the healing of the repaired root and suppressed osteoarthritis progression. Knee Surg Sports Traumatol Arthrosc. 2021;29(4):1258–68. Hiranaka T, Furumatsu T, Yokoyama Y, et al. The clinical and radiographic outcomes of type 2 medial meniscus posterior root tears following transtibial pullout repair. Knee Surg Sports Traumatol Arthrosc. 2023;31:2323–30. Yoon KH, Lee W, Park JY. Outcomes of Arthroscopic All-Inside Repair Are Improved Compared to Transtibial Pull-Out Repair of Medial Meniscus Posterior Root Tears. Arthroscopy. 2023;39:1254–61. Omae H, Yanagisawa S, Hagiwara K, et al. Arthroscopic pullout repair versus suture anchor repair for medial meniscus posterior root tear combined with high tibial osteotomy. Knee. 2023;45:117–27. Bachmaier S, Krych AJ, Smith PA, Feucht MJ, LaPrade RF, Wijdicks CA. Biomechanical Performance of Transtibial Pull-Out Posterior Horn Medial Meniscus Root Repair Is Improved With Knotless Adjustable Suture Anchor-Based Fixation. Orthop J Sports Med. 2024;12(4):23259671241239575. Chung KS, Ha JK, Yeom CH, Ra HJ, Jang HS, Choi SH, Kim JG. Comparison of Clinical and Radiologic Results Between Partial Meniscectomy and Refixation of Medial Meniscus Posterior Root Tears: A Minimum 5-Year Follow-up. Arthroscopy. 2015;31(10):1941–50. Saengpetch N, Noowan S, Boonrod A, Jaruwanneechai K, Sumanont S, Vijittrakarnrung C. Comparison of medial tibiofemoral joint mechanics between all-suture anchor and transtibial pullout technique for posterior medial meniscal root tears. J Orthop Surg Res. 2023;18(1):591. Sundararajan SR, Ramakanth R, Sethuraman AS, Kannan M, Rajasekaran S. Correlation of factors affecting correction of meniscal extrusion and outcome after medial meniscus root repair. Arch Orthop Trauma Surg. 2022;142(5):823–34. Moon HK, Koh YG, Kim YC, Park YS, Jo SB, Kwon SK. Prognostic factors of arthroscopic pull-out repair for a posterior root tear of the medial meniscus. Am J Sports Med. 2012;40(5):1138–43. Chung KS, Ha JK, Ra HJ, Nam GW, Kim JG. Pullout Fixation of Posterior Medial Meniscus Root Tears: Correlation Between Meniscus Extrusion and Midterm Clinical Results. Am J Sports Med. 2017;45(1):42–9. Feucht MJ, Kühle J, Bode G, Mehl J, Schmal H, Südkamp NP, Niemeyer P. Arthroscopic Transtibial Pullout Repair for Posterior Medial Meniscus Root Tears: A Systematic Review of Clinical, Radiographic, and Second-Look Arthroscopic Results. Arthroscopy. 2015;31(9):1808–16. Tamura M, Furumatsu T, Yokoyama Y, Higashihara N, Kawada K, Ozaki T. Initial tension at suture fixation affects the suture breakage following medial meniscus posterior root repair: A retrospective cohort study. J ISAKOS. 2024;9(3):258–63. Stärke C, Kopf S, Lippisch R, Lohmann CH, Becker R. Tensile forces on repaired medial meniscal root tears. Arthroscopy. 2013;29(2):205–12. Kawada K, Okazaki Y, Tamura M, Yokoyama Y, Ozaki T, Furumatsu T. Accurate tibial tunnel position in transtibial pullout repair for medial meniscus posterior root tears delays the progression of medial joint space narrowing. Knee Surg Sports Traumatol Arthrosc. 2024;32(8):2023–31. Kamatsuki Y, Furumatsu T, Hiranaka T, Okazaki Y, Okazaki Y, Kodama Y, Hino T, Masuda S, Miyazawa S, Ozaki T. Placement of an anatomic tibial tunnel significantly improves the medial meniscus posterior extrusion at 90° of knee flexion following medial meniscus posterior root pullout repair. Knee Surg Sports Traumatol Arthrosc. 2021;29(4):1025–34. Kim KI, Bae JK, Jeon SW, Kim GB. Medial Meniscus Posterior Root Tear Does Not Affect the Outcome of Medial Open-Wedge High Tibial Osteotomy. J Arthroplasty. 2021;36(2):423–8. Karatekin YS, Altinayak H. Assessment of Radiological Outcomes of Medial Meniscus Posterior Root Tears Associated With Meniscal Extrusions After Open Wedge High Tibial Osteotomy. Cureus. 2023;15(10):e46884. Nha KW, Lee YS, Hwang DH, Kwon JH, Chae DJ, Park YJ, Kim JI. Second-look arthroscopic findings after open-wedge high tibia osteotomy focusing on the posterior root tears of the medial meniscus. Arthroscopy. 2013;29(2):226–31. Choi YS, Chang MJ, Lee JH, Lee JH, D'Lima DD, Kim TW, Chang CB, Kang SB. Repair of medial meniscus posterior root tear is effective for root healing and cartilage regeneration in opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2023;31(12):5799–811. Ke X, Qiu J, Chen S, Sun X, Wu F, Yang G, Zhang L. Concurrent arthroscopic meniscal repair during open-wedge high tibial osteotomy is not clinically beneficial for medial meniscus posterior root tears. Knee Surg Sports Traumatol Arthrosc. Seo HS, Lee SC, Jung KA. Second-look arthroscopic findings after repairs of posterior root tears of the medial meniscus. Am J Sports Med. 2011;39(1):99–107. Lee OS, Lee SH, Lee YS. Comparison of the Radiologic, Arthroscopic, and Clinical Outcomes between Repaired versus Unrepaired Medial Meniscus Posterior Horn Root Tear During Open Wedge High Tibial Osteotomy. J Knee Surg. 2021;34(1):57–66. Turgut A, Kayali C, Ağuş H. Radiological analysis of closed-wedge high tibial osteotomy. Eklem Hastalik Cerrahisi. 2012;23(2):82–7. LaPrade RF, Oro FB, Ziegler CG, Wijdicks CA, Walsh MP. Patellar height and tibial slope after opening-wedge proximal tibial osteotomy: a prospective study. Am J Sports Med. 2010;38(1):160–70. Song GY, Zhang H, Zhang J, Liu X, Xue Z, Qian Y, Feng H. Greater Static Anterior Tibial Subluxation of the Lateral Compartment After an Acute Anterior Cruciate Ligament Injury Is Associated With an Increased Posterior Tibial Slope. Am J Sports Med. 2018;46(7):1617–23. Webb JM, Salmon LJ, Leclerc E, Pinczewski LA, Roe JP. Posterior tibial slope and further anterior cruciate ligament injuries in the anterior cruciate ligament-reconstructed patient. Am J Sports Med. 2013;41(12):2800–4. Ji S, Gao Y, Zhang J, Pan F, Zhu K, Jiang X, Zhou Y. High tibial lateral closing wedge and opening wedge valgus osteotomy produce different effects on posterior tibial slope and patellar height. Front Surg. 2023;10:1219614. Additional Declarations No competing interests reported. Supplementary Files IRB.pdf Cite Share Download PDF Status: Published Journal Publication published 07 Feb, 2026 Read the published version in Journal of Orthopaedic Surgery and Research → Version 1 posted Editorial decision: Revision requested 24 Nov, 2025 Reviews received at journal 18 Nov, 2025 Reviewers agreed at journal 13 Nov, 2025 Reviews received at journal 23 Oct, 2025 Reviewers agreed at journal 23 Oct, 2025 Reviewers agreed at journal 19 Oct, 2025 Reviewers invited by journal 15 Oct, 2025 Editor assigned by journal 13 Oct, 2025 Submission checks completed at journal 13 Oct, 2025 First submitted to journal 12 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7840788","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":535232813,"identity":"286044f8-18c0-43b3-a22c-72abd7141dff","order_by":0,"name":"Xinda Zhang","email":"","orcid":"","institution":"The Third Hospital of Hebei Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xinda","middleName":"","lastName":"Zhang","suffix":""},{"id":535232814,"identity":"ea56ad4a-9ae3-43b2-920c-4b42030f5cfb","order_by":1,"name":"Yi Zheng","email":"","orcid":"","institution":"The Third Hospital of Hebei Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yi","middleName":"","lastName":"Zheng","suffix":""},{"id":535232815,"identity":"56f5eb3e-5f2e-41e4-b0a7-363c02ac31b8","order_by":2,"name":"Yingzhen Niu","email":"","orcid":"","institution":"The Third Hospital of Hebei Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yingzhen","middleName":"","lastName":"Niu","suffix":""},{"id":535232817,"identity":"ee552f6d-f568-4508-9d22-b2a86cf0efd8","order_by":3,"name":"Conglei Dong","email":"","orcid":"","institution":"The Third Hospital of Hebei Medical University","correspondingAuthor":false,"prefix":"","firstName":"Conglei","middleName":"","lastName":"Dong","suffix":""},{"id":535232818,"identity":"e2fba45d-5f6e-4a0b-abd2-aa81dc54a99a","order_by":4,"name":"Zhuangdai Zhang","email":"","orcid":"","institution":"The Third Hospital of Hebei Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zhuangdai","middleName":"","lastName":"Zhang","suffix":""},{"id":535232819,"identity":"e26b0f2a-3523-41db-8dc5-22ff65d7d82a","order_by":5,"name":"Jiangtao Dong","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAtElEQVRIiWNgGAWjYDCCAwcYHwNJMFuCSC2HmY1J1cLMJk2aFr6D549VF1TciTY4wHzwNg+DXR5BLZIHDrPdnnHmWe6GA2zJ1jwMycUEtRiAtPC2HQZq4TGT5mE4kNhAjJZi3n8gLfzfiNfCzNsAtoWNOC1AvxhL8xx7ljvzMJux5RyDZMJa+G4cfPiZp+ZObt/x5oc33lTYEdbCIHEAymAGu5OgeiDgJ2zqKBgFo2AUjHQAAO9KRBi4vGmuAAAAAElFTkSuQmCC","orcid":"","institution":"The Third Hospital of Hebei Medical University","correspondingAuthor":true,"prefix":"","firstName":"Jiangtao","middleName":"","lastName":"Dong","suffix":""},{"id":535232820,"identity":"cdd9491d-a6ba-4e67-8f00-d69e356b5c74","order_by":6,"name":"Siman Tian","email":"","orcid":"","institution":"The Third Hospital of Hebei Medical University","correspondingAuthor":false,"prefix":"","firstName":"Siman","middleName":"","lastName":"Tian","suffix":""}],"badges":[],"createdAt":"2025-10-12 13:08:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7840788/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7840788/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13018-026-06712-8","type":"published","date":"2026-02-07T15:57:17+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":94709367,"identity":"1183cbe7-a2bc-4b55-977d-16e83d8b734b","added_by":"auto","created_at":"2025-10-30 01:07:02","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":2091563,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.docx","url":"https://assets-eu.researchsquare.com/files/rs-7840788/v1/7dc58d80117b0ba0063db810.docx"},{"id":94709365,"identity":"fd66f6bb-1901-4934-b011-8f390d4644a9","added_by":"auto","created_at":"2025-10-30 01:07:02","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":8963,"visible":true,"origin":"","legend":"","description":"","filename":"3b6c14c1c7c94d098ff4b6ac1763b06a.json","url":"https://assets-eu.researchsquare.com/files/rs-7840788/v1/d05d8f1a99a4311076c06480.json"},{"id":94709366,"identity":"64694251-2dee-4b21-84eb-a94869d5e680","added_by":"auto","created_at":"2025-10-30 01:07:02","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":311562,"visible":true,"origin":"","legend":"","description":"","filename":"IRB.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7840788/v1/9f05d1e315045c2311990050.pdf"},{"id":94709370,"identity":"352371a2-b1be-44a8-9509-79cf3efe47a9","added_by":"auto","created_at":"2025-10-30 01:07:02","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":13927,"visible":true,"origin":"","legend":"","description":"","filename":"coverletterd1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7840788/v1/2c899c70c3b14e4b8e434a6b.docx"},{"id":94729564,"identity":"26b36901-7781-456c-b387-57bb790c4e83","added_by":"auto","created_at":"2025-10-30 07:05:09","extension":"xml","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":120273,"visible":true,"origin":"","legend":"","description":"","filename":"3b6c14c1c7c94d098ff4b6ac1763b06a1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7840788/v1/9e257e25695346f100d5d433.xml"},{"id":94709378,"identity":"a83022e9-b9bf-47c5-a953-eb15eefb70a9","added_by":"auto","created_at":"2025-10-30 01:07:02","extension":"png","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":433074,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-7840788/v1/87a6874001ca15bff806f09b.png"},{"id":94709383,"identity":"5c6e835e-2336-439e-a924-60f293266f39","added_by":"auto","created_at":"2025-10-30 01:07:02","extension":"png","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":236085,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-7840788/v1/6da2430c379b98e66d2faf2c.png"},{"id":94709385,"identity":"62367771-879a-4af1-b3f4-fea5df935d08","added_by":"auto","created_at":"2025-10-30 01:07:02","extension":"png","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":325490,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage6.png","url":"https://assets-eu.researchsquare.com/files/rs-7840788/v1/e7a22efa5592845c3ea623db.png"},{"id":94729204,"identity":"c2a75ace-79fa-4174-9180-b00f79c6d6cc","added_by":"auto","created_at":"2025-10-30 07:04:41","extension":"png","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":57221,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7840788/v1/d115e45e8eddd71507fab0c7.png"},{"id":94729261,"identity":"650dab01-7255-4c97-a6dc-10de1ca737fb","added_by":"auto","created_at":"2025-10-30 07:04:43","extension":"png","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":29439,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7840788/v1/e309f7d42f9dbc9d1e807c6a.png"},{"id":94709382,"identity":"da09d327-1069-4995-9332-3f6d901d2092","added_by":"auto","created_at":"2025-10-30 01:07:02","extension":"png","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":59736,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7840788/v1/78e1931efd1969fc7be48d75.png"},{"id":94728961,"identity":"12b6b3e5-e95f-48d4-9de1-d147c366b324","added_by":"auto","created_at":"2025-10-30 07:04:26","extension":"png","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":54890,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-7840788/v1/3e9879b3bbe0475758431b54.png"},{"id":94729880,"identity":"30e30c83-8bfa-4afd-b00c-e9feef21dfbc","added_by":"auto","created_at":"2025-10-30 07:05:27","extension":"png","order_by":15,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":43927,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-7840788/v1/b132072372e13577f98d5d85.png"},{"id":94709381,"identity":"df12ed5d-923b-4d34-aca1-70279afb9615","added_by":"auto","created_at":"2025-10-30 01:07:02","extension":"png","order_by":16,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":34424,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage6.png","url":"https://assets-eu.researchsquare.com/files/rs-7840788/v1/d837ffbedd29849c66658aba.png"},{"id":94709386,"identity":"83c9c6fc-6bc2-49f2-b2b5-3411fb2d27fa","added_by":"auto","created_at":"2025-10-30 01:07:03","extension":"xml","order_by":17,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":118749,"visible":true,"origin":"","legend":"","description":"","filename":"3b6c14c1c7c94d098ff4b6ac1763b06a1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7840788/v1/4089fd9883128813b5cb46d6.xml"},{"id":94709377,"identity":"52041bfa-f258-4526-b818-cb82ed15f77a","added_by":"auto","created_at":"2025-10-30 01:07:02","extension":"html","order_by":18,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":125989,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7840788/v1/775e44bff2df323c1c16ffe7.html"},{"id":94728502,"identity":"bb142958-43b8-40a7-a2e2-67baae68791a","added_by":"auto","created_at":"2025-10-30 07:03:56","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":283318,"visible":true,"origin":"","legend":"\u003cp\u003ePull ASA into bone tunnel\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7840788/v1/e8eb2e60ddb1dfe66d5019a5.png"},{"id":94729471,"identity":"36424017-21c6-4dc8-b3bc-6d8a909c0173","added_by":"auto","created_at":"2025-10-30 07:05:01","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":323925,"visible":true,"origin":"","legend":"\u003cp\u003eMeasure the medial meniscus extrusion rate\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7840788/v1/d16e51cc53e008b1699d722c.png"},{"id":94709376,"identity":"4b15f3a1-bba4-4ea0-b409-3fe062e6ff9a","added_by":"auto","created_at":"2025-10-30 01:07:02","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":435255,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7840788/v1/81cb942c9182529aeef234db.png"},{"id":94729758,"identity":"a6b8d9fd-a513-4d5a-8a97-1b4736db427d","added_by":"auto","created_at":"2025-10-30 07:05:22","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":49646,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7840788/v1/a5b87daa1af0e83563e482a0.jpg"},{"id":102236247,"identity":"43e118f4-446f-4aa0-be0d-a04f76cdda39","added_by":"auto","created_at":"2026-02-09 16:20:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2317608,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7840788/v1/129c3735-f6bd-4857-b9a1-9fcf0f1f137e.pdf"},{"id":94709373,"identity":"39a2a476-2d0f-40dc-9fac-b827473c7a09","added_by":"auto","created_at":"2025-10-30 01:07:02","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":311562,"visible":true,"origin":"","legend":"","description":"","filename":"IRB.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7840788/v1/43844c8cfe9aa1bd136ff22f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Arthroscopic All-in Technique Combined with High Tibial Osteotomy for Osteoarthritis with Posterior Root Tear of the Medial Meniscus","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMedial Meniscus Posterior Root Tears (MMPRTs) have gained significant clinical attention in recent years due to their unique location. Defined as radial tears within 1 cm of the bony attachment or avulsion injuries at the tibial insertion, MMPRTs account for approximately 10%-21% of all meniscal surgeries\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Biomechanically, MMPRTs disrupt hoop tension, leading to pathological medial meniscus extrusion, increased medial compartment contact pressure (comparable to total meniscectomy), and ultimately accelerated osteoarthritis (OA) progression\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Evidence suggests MMPRTs repair yields better clinical outcomes than partial meniscectomy, with one long-term (10-year) follow-up reporting lower rates of subsequent total knee arthroplasty (TKA) after repair versus resection\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Therefore, repairing MMPRTs is critical for restoring hoop tension, distributing stress, and preventing OA progression\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eVarus limb alignment is a significant risk factor for both MMPRTs and meniscal extrusion, with varus\u0026thinsp;\u0026gt;\u0026thinsp;5\u0026deg; considered a poor prognostic factor for repair success\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. High tibial osteotomy (HTO) for medial compartment OA with varus alignment has been shown to slow OA progression\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. Consequently, combining HTO with MMPRTs repair represents a logical treatment strategy, with prior studies reporting good outcomes using pullout repair techniques alongside HTO\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eHowever, traditional pullout techniques can be complicated by suture interference with HTO plates/screws, the \"bungee effect,\" suture wear, and creep\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. To address these issues, we propose the innovative use of all-suture anchor (ASA) for MMPRTs repair in conjunction with HTO. Recent biomechanical studies support the effectiveness of ASA for medial meniscus posterior root repair\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e, but no clinical studies have evaluated ASA repair combined with HTO for MMPRTs with medial compartment OA.\u003c/p\u003e\u003cp\u003eThis study aims to assess the clinical scores, radiological outcomes, and second-look arthroscopic findings following arthroscopic ASA repair combined with HTO for MMPRTs with medial compartment OA. We hypothesize that this combined approach can repair the posterior root of the medial meniscus, significantly enhances patient outcomes, and delays OA progression.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\n\u003ch3\u003e1. Clinical Data\u003c/h3\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e1.1 Study Population\u003c/h2\u003e\u003cp\u003eThis retrospective study analyzed patients with medial compartment osteoarthritis (OA) and medial meniscus posterior rotator tears (MMPRTs) who underwent arthroscopic ASA suturing of MMPRTs combined with high tibial osteotomy (HTO) at our hospital between June 2022 and June 2023. All patients underwent arthroscopic second-look exploration during secondary surgery to remove internal fixation devices. After screening, 43 patients met the inclusion criteria. Among these, 7 patients were lost to follow-up, resulting in a final cohort of 36 patients.\u003c/p\u003e\u003cp\u003eSenior surgeons performed all procedures. Ethical approval was obtained (IRB No. 2024-092-1).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e1.2 Inclusion Criteria\u003c/h2\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eLaprade type 2 MMPRTs confirmed on Magnetic Resonance Imaging(MRI)(ghost sign, truncation sign).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eMedial compartment OA, K-L grade II-III.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eMedial proximal tibial angle (mPTA)\u0026thinsp;\u0026lt;\u0026thinsp;85\u0026deg;.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eAge 40\u0026ndash;65 years.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eMedial tibiofemoral cartilage Outerbridge grade\u0026thinsp;\u0026le;\u0026thinsp;3.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eLaprade classfication:\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eType I is an isolated, stable partial tear at the root of the meniscus.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eType 2 is a complete radial tear at the root of the meniscus.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eType 3 is a tear with a concomitant longitudinal/circumferential tear (commonly referred to as a \u0026ldquo;bucket handle\u0026rdquo; tear).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eType 4 involves an oblique meniscus tear extending to the meniscus root, resulting in complete root avulsion.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eType 5 describes a complete avulsion fracture at the base of the tibial plateau attachment site.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e1.3Exclusion Criteria\u003c/h2\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eRequirement for concurrent ligament reconstruction or other major soft tissue procedures.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePrevious knee surgery on the affected side.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eFailed primary MMPRTs repair.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eIncomplete medical records or loss to follow-up.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e1.4 General Data\u003c/h2\u003e\u003cp\u003eCollected data included sex, age, BMI, affected side, and postoperative complications.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003e2. Surgical Technique\u003c/h3\u003e\n\u003cp\u003ePatients were positioned supine. Following standard sterilization and draping, standard anteromedial (AM) and anterolateral (AL) arthroscopic portals were established. The knee was examined under gentle valgus stress, maintained between 0\u0026ndash;30\u0026deg; flexion. Intra-articular structures (menisci, ACL, PCL, cartilage) were assessed. The medial meniscus posterior root was visualized via the AL portal. If access to the medial compartment was tight, pie-crusting release of the posterior oblique fibers of the superficial medial collateral ligament (sMCL) was performed to confirm the MMPRTs. The root remnant and tibial footprint were debrided and freshened using a shaver and curette. A 2.4mm guide pin was drilled through a tibial guide targeting the anatomical root footprint. An epidural needle loaded with No. 1 PDS suture was passed through the tibial tunnel into the joint, and a suture retriever pulled the PDS out through the AM portal. The knot of the ASA was disengaged from its base and threaded through the PDS loop. Under arthroscopic visualization, the PDS suture was used to pull the ASA knot into the bone tunnel until flush with the cortex (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Tensioning the ASA tails deployed the anchor beneath the cortex, and the PDS was removed. The torn root was then sutured approximately 5mm medial to the tear margin using a combination of loop and simple stitches under appropriate tension. Stability was confirmed with a probe (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFollowing arthroscopy, a 7-cm longitudinal incision was made over the proximal medial tibia. After releasing the superior border of the pes anserinus and distal sMCL fibers, Hohmann retractors were placed to protect posterior neurovascular structures. A Kirschner wire was drilled 35mm distal to the medial joint line, directed towards the fibular head, ending 5mm short of the lateral cortex. Fluoroscopy confirmed correct position before performing the osteotomy along the wire, carefully avoiding posterior structures. A second biplanar osteotomy cut was made\u0026thinsp;\u0026ge;\u0026thinsp;10mm proximal to the first cut, starting at the patellar tendon insertion and angled at 110\u0026deg;. The osteotomy gap was opened according to the preoperatively calculated correction angle and intraoperative cartilage status (Outerbridge grade): the mechanical axis was aimed at 50\u0026ndash;55% of the medial tibial plateau width for Outerbridge grade 1\u0026ndash;2 cartilage damage, and at Fujisawa's point for Outerbridge grade 3 damage. An osteotomy plate was fixed medially. The joint was irrigated, a drain placed, and the wound closed in layers.\u003c/p\u003e\n\u003ch3\u003e3.Postoperative Rehabilitation\u003c/h3\u003e\n\u003cp\u003eQuadriceps isometrics and straight leg raises began immediately postoperatively. Touch-down weight-bearing with crutches was permitted. Knee flexion was limited to \u0026lt;\u0026thinsp;90\u0026deg; for the first 4 weeks. Partial weight-bearing commenced at 4\u0026ndash;6 weeks, progressing to full weight-bearing by 6 weeks. Deep squatting was avoided for 3 months.\u003c/p\u003e\n\u003ch3\u003e4.Outcome Assessment\u003c/h3\u003e\n\u003cp\u003eTwo authors measured the preoperative and postoperative data, and the consistency analysis was performed.To test the reliability of the measurements,two authors measured all of the images independently. One of the two authors repeated the measurements 2 weeks later.Clinical assessment utilized the Tegner activity score, Lysholm score, IKDC score, and KOOS preoperatively and at final follow-up.Standing full-length weight-bearing radiographs obtained preoperatively and at hardware removal were used to assess K-L grade, HKA, mPTA, JLCA, and PTS. Preoperative and post-hardware removal MRI (1.5-T Achieva, Philips) assessed MMER. MMER (%) was calculated as: (Extruded meniscus width / Total meniscus width) x 100. Measurements were taken on three consecutive slices at the MCL level and averaged (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). All patients underwent second-look arthroscopy during hardware removal. Root healing status was categorized as:\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eComplete Healing: No tear, good synovial coverage, stable on probing.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePartial Healing: Continuity present but reduced tension on probing.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eFailure: No continuity, no tension, no evidence of healing.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eSPSS version 24.0 was used. Continuous data are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD). Paired t-tests compared pre- and postoperative scores and imaging parameters. For subgroup analysis, Complete and Partial Healing were combined into a \"Healed\" group and compared to the \"Failure\" group using independent t-tests or Mann-Whitney U tests as appropriate. P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.The interobserver and intraobserver reliabilities for measurements were verified by the intraclass correlation coefficient (ICC). ICC values between 0.8 and 0.9 were considered good.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe study finally enrolled 36 patients: 30 females (83.3%) and 6 males (16.7%), mean age 58.92\u0026thinsp;\u0026plusmn;\u0026thinsp;5.12 years. There were 21 right knees and 15 left knees. Mean follow-up duration was 24.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4 months. No complications (infection, nonunion, neurovascular issues) occurred by final follow-up. Patient demographic data are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePatient demographics and posterior root healing status\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePain Duration (mo)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSide\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eFU (mo)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eHealing Status\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eComplete Healing\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePartial Healing\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFailure\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFailure\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePartial Healing\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePartial Healing\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eComplete Healing\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFailure\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFailure\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePartial Healing\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFailure\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePartial Healing\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFailure\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eComplete Healing\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFailure\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePartial Healing\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFailure\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePartial Healing\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eComplete Healing\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eComplete Healing\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFailure\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eComplete Healing\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFailure\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFailure\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFailure\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eComplete Healing\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFailure\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFailure\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFailure\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eComplete Healing\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFailure\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eComplete Healing\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eComplete Healing\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFailure\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePartial Healing\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFailure\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSignificant improvements were observed in all clinical scores at final follow-up: Lysholm scores improved from 46.58\u0026thinsp;\u0026plusmn;\u0026thinsp;16.04 to 79.08\u0026thinsp;\u0026plusmn;\u0026thinsp;14.29, IKDC scores from 37.08\u0026thinsp;\u0026plusmn;\u0026thinsp;14.57 to 65.81\u0026thinsp;\u0026plusmn;\u0026thinsp;12.33, KOOS scores decreased (indicating improvement) from 116.50\u0026thinsp;\u0026plusmn;\u0026thinsp;26.13 to 65.89\u0026thinsp;\u0026plusmn;\u0026thinsp;15.50, and Tegner activity scores from 1.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.27 to 2.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.15 (all P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Subgroup analysis showed no significant differences in postoperative Lysholm, IKDC, KOOS, or Tegner scores, or in K-L grade, between the healed group and the non-healed group (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of preoperative and final follow-up clinical scores and imaging\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePreop\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFinal FU\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003et-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTegner\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e1.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e2.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-7.135\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIKDC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e37.08\u0026thinsp;\u0026plusmn;\u0026thinsp;14.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e65.81\u0026thinsp;\u0026plusmn;\u0026thinsp;12.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-10.589\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKOOS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e116.50\u0026thinsp;\u0026plusmn;\u0026thinsp;26.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e65.89\u0026thinsp;\u0026plusmn;\u0026thinsp;15.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12.009\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLysholm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e46.58\u0026thinsp;\u0026plusmn;\u0026thinsp;16.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e79.08\u0026thinsp;\u0026plusmn;\u0026thinsp;14.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-11.190\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMMER(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e31.61\u0026thinsp;\u0026plusmn;\u0026thinsp;11.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e32.53\u0026thinsp;\u0026plusmn;\u0026thinsp;10.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.681\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.500\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHKA(\u0026deg;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e173.02\u0026thinsp;\u0026plusmn;\u0026thinsp;2.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e179.96\u0026thinsp;\u0026plusmn;\u0026thinsp;2.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-19.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003emPTA(\u0026deg;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e84.96\u0026thinsp;\u0026plusmn;\u0026thinsp;2.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e90.06\u0026thinsp;\u0026plusmn;\u0026thinsp;1.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-15.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJLCA(\u0026deg;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e1.96\u0026thinsp;\u0026plusmn;\u0026thinsp;1.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e1.93\u0026thinsp;\u0026plusmn;\u0026thinsp;1.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.203\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.840\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePTS(\u0026deg;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e9.76\u0026thinsp;\u0026plusmn;\u0026thinsp;3.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e11.65\u0026thinsp;\u0026plusmn;\u0026thinsp;3.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-3.355\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eK-L分级\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e1.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e1.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-3.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.661\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eTegner: Tegner activity score;IKDC༚International Knee Documentation Committee score༛KOOS:Knee injury and osteoarthristyis outcome score;Lysholm:Lysholm score;MMER:Medial Meniscus Extrusion Rate\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSubgroup analysis of root healing status after semilunar\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTegener\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eKOOS\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eIKDC\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eLysholm\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMMER(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eK-L\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003ePain duration(mo)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealed Group (n\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.39\u0026thinsp;\u0026plusmn;\u0026thinsp;1.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e68.67\u0026thinsp;\u0026plusmn;\u0026thinsp;16.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e62.50\u0026thinsp;\u0026plusmn;\u0026thinsp;11.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e77.89\u0026thinsp;\u0026plusmn;\u0026thinsp;15.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e32.82\u0026thinsp;\u0026plusmn;\u0026thinsp;8.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.94\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e21.50\u0026thinsp;\u0026plusmn;\u0026thinsp;37.59\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFailure Group (n\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.28\u0026thinsp;\u0026plusmn;\u0026thinsp;1.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e63.11\u0026thinsp;\u0026plusmn;\u0026thinsp;14.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e69.11\u0026thinsp;\u0026plusmn;\u0026thinsp;12.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e80.28\u0026thinsp;\u0026plusmn;\u0026thinsp;13.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e32.23\u0026thinsp;\u0026plusmn;\u0026thinsp;12.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e14.22\u0026thinsp;\u0026plusmn;\u0026thinsp;14.82\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.776\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.289\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.109\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.623\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.868\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.450\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSignificant coronal plane correction was achieved, with the HKA improving from a preoperative mean of 173.02\u0026thinsp;\u0026plusmn;\u0026thinsp;2.43\u0026deg; to 179.96\u0026thinsp;\u0026plusmn;\u0026thinsp;2.27\u0026deg; at final follow-up. The mean posterior tibial slope (PTS) increased significantly from 9.76\u0026thinsp;\u0026plusmn;\u0026thinsp;3.24\u0026deg; preoperatively to 11.65\u0026thinsp;\u0026plusmn;\u0026thinsp;3.85\u0026deg; at final follow-up (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). There was no significant change between preoperative and postoperative K-L grades (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003eOn final follow-up MRI, the medial meniscus extrusion rate (MMER) increased in 17 patients (47%) and decreased in 19 patients (53%). The mean MMER increased slightly from 31.61\u0026thinsp;\u0026plusmn;\u0026thinsp;11.74% to 32.53\u0026thinsp;\u0026plusmn;\u0026thinsp;10.33%, but this change was not statistically significant (P\u0026thinsp;=\u0026thinsp;0.5).\u003c/p\u003e\u003cp\u003eSecond-look arthroscopy findings: 10 patients (28%) demonstrated complete healing (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e4\u003c/span\u003eA), 8 (22%) partial healing, and 18 (50%) failure (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e4\u003c/span\u003eB-C). All patients showed clinical improvement. Subgroup analysis comparing the Healed group (Complete\u0026thinsp;+\u0026thinsp;Partial) to the Failure group revealed no significant differences in postoperative Tegner, IKDC, KOOS, Lysholm scores, MMER, symptom duration, or K-L grade (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05 for all, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eWith respect to the intra- and interobserver reliability,excellent agreement was observed for both reliability measures for pre- and postoperative measurements (ICC values ranging from 0.83 to 0.89) .(Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e,\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eIntra observer CCS\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre-op\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePost-op\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMMER\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.86\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHKA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.88\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003emPTA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.86\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePTS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.89\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eInter observer CCS\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre-op\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePost-op\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMMER\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.84\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHKA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.88\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003emPTA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.84\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePTS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.84\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe key finding of this study was that arthroscopic ASA repair combined with HTO significantly improved short-term clinical outcomes in patients with MMPRTs and medial compartment OA at a mean follow-up of 24.8 months. Second-look arthroscopy revealed complete healing in 28% and partial healing in 22% of roots. Crucially, the status of root healing showed no correlation with the observed clinical improvements.\u003c/p\u003e\u003cp\u003eSignificant enhancements in Lysholm, IKDC, KOOS, and Tegner scores demonstrate the efficacy of this combined technique, achieving outcomes comparable to those reported for pullout repair combined with HTO\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. This is the first clinical report on ASA combined with HTO. ASA repair offers potential advantages over pullout techniques, including avoiding suture-plate/screw interference, the \"bungee effect,\" suture wear, and creep\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e, and potentially reducing risk to posterior neurovascular structures compared to suture anchor. The tibial tunnel placement also avoids conflict with the HTO site. By reducing medial compartment pressure, HTO may create a more favorable environment for root healing. Biomechanically, ASA have shown superiority to pullout techniques in restoring contact area under load, achieving near-normal tibiofemoral contact mechanics\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e.The relatively short follow-up period of our study may account for this discrepancy.\u003c/p\u003e\u003cp\u003eWhile MMPRTs repair aims to restore function and prevent OA progression, medial meniscus extrusion (MME) remains a key risk factor for OA advancement. Studies on MME correction post-repair show conflicting results\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. Our study found no significant overall change in MMER, suggesting root repair alone may not consistently resolve extrusion; factors like surgical technique, rehabilitation protocol, and healing status likely influence MME. Chung et al.\u003csup\u003e16\u003c/sup\u003e reported K-L progression in 68% of patients after pullout repair at short-term follow-up. In contrast, only 8% (3/36) of our cohort showed K-L progression at 2 years, with 86% stable and 6% improved. This suggests the combination of HTO with repair may better delay OA progression, although significant reversal is unlikely.\u003c/p\u003e\u003cp\u003eOur second-look healing rates (28% complete, 22% partial, 50% failure) are lower than the 48% complete, 42% partial, and 10% failure reported in a systematic review\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. We frequently observed suture cut-through as a primary failure cause, potentially due to excessive tension during fixation or premature loading during rehabilitation. Biomechanical studies suggest optimal initial suture tension is around 30N\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e, and weight-bearing or motion exceeding the repair's tolerance can generate damaging forces\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. The learning curve associated with this technique might also have contributed to suboptimal tunnel placement in some cases. Accurate anatomical tunnel positioning (posterolateral direction) is critical for reducing extrusion and improving healing rates\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eMost significantly, subgroup analysis revealed no difference in clinical outcomes between patients with healed versus non-healed roots. This implies that for patients with MMPRTs and varus malalignment, HTO alone may yield good clinical results even if the root fails to heal. The mechanical correction provided by HTO, altering medial compartment pressure and the local microenvironment, appears to be the pivotal factor driving clinical improvement. This finding aligns with several studies reporting comparable outcomes between HTO alone and HTO combined with MMPRTs repair\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. Nha et al.\u003csup\u003e24\u003c/sup\u003e observed high rates of spontaneous root healing after HTO alone, unrelated to clinical improvement. Ke et al.\u003csup\u003e26\u003c/sup\u003e and Seo et al.\u003csup\u003e27\u003c/sup\u003e found no significant benefit from adding root repair to HTO. Lee et al.\u003csup\u003e28\u003c/sup\u003e concluded there is no clear evidence mandating concurrent MMPRTs repair during HTO.\u003c/p\u003e\u003cp\u003eThe significant postoperative increase in PTS warrants attention. This likely stems from greater anterior gap opening during medial opening-wedge HTO. Contributing factors include easier surgical access anteriorly, plate placement location (more anterior placement increases PTS)\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e, and greater resistance from posterior soft tissues (sMCL origin)\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. Increased PTS is a known risk factor for ACL/PCL injury\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e,\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e. Mitigation strategies include placing distractors posteriorly to create a slightly trapezoidal gap and ensuring adequate release of the pes anserinus/sMCL\u003csup\u003e33\u003c/sup\u003e.\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eThis study has limitations inherent to its retrospective design, including potential selection bias. The sample size is relatively small, and the follow-up period is short-term; larger, long-term studies are needed. The learning curve associated with the ASA technique may have affected tunnel placement accuracy and suture tension control, potentially influencing healing rates.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eArthroscopic ASA repair combined with HTO significantly improves short-term clinical outcomes in patients with medial compartment OA and MMPRTs. Crucially, the healing status of the medial meniscus posterior root showed no correlation with these short-term clinical outcomes and did not influence the clinical presentation after HTO.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003cp\u003e This study conforms to the provisions of the Declaration of Helsinki and has been reviewed and approved by the Institutional Review Board (IRB) of the Third Hospital of Hebei Medical University (IRB number: KE 2024-092-1).The patient had given the informed consent to allow their information to be used in research purposes and informed consent was obtained from the participant. Clinical trial number: not applicable.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eNone\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eJ.T.D. carried out and designed the study. X.D.Z., Y.Z., Y.Z.N. analyzed the data. All authors contributed to data collection. Y.Z. and X.D.Z. wrote the manuscript., and J.T.D. approved the final version of the manuscript. All of the authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e\u003cp\u003eWe sincerely thank the patient in this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eAll data generated or analysed during this study are included in this published article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eChoi SH. The MRI findings of meniscal root tear of the medial meniscus: emphasis on coronal, sagittal and axial images. Knee Surg Sports Traumatol Arthrosc; 2012.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBhatia S. Meniscal root tears: significance, diagnosis, and treatment. Am J Sports Med. 2014;42(12):3016\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBerk AN, Cregar WM, Wang S et al. The Effect of Lower Limb Alignment on Tibiofemoral Joint Contact Biomechanics after Medial Meniscus Posterior Root Repair:A Finite-Element Analysis. J Am Acad OrthopSurg.PublishedonlineApril19,2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLamba A, Regan C, Levy BA, Stuart MJ, Krych AJ, Hevesi M. Long-term Outcomes of Partial Meniscectomy for Degenerative Medial Meniscus Posterior Root Tears. Orthop J Sports Med. 2024;12(9):23259671241266593.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGraham BC, Weiss-Laxer NS, Haider MN, Marzo JM. Item-Specific Knee Injury and Osteoarthritis Outcome Score Characterization of Patients With Medial Meniscus Root Tear. Orthop J Sports Med. 2024;12(4):23259671241241094. Published 2024 Apr 12.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChung KS, Ha JK, Ra HJ, Kim JG. Preoperative varus alignment and postoperative meniscus extrusion are the main long-term predictive factors of clinical failure of meniscal root repair. Knee Surg Sports Traumatol Arthrosc. 2021;29(12):4122\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKim YM, Joo YB, Lee WY, Kim YK. Remodified Mason-Allen suture technique concomitant with high tibial osteotomy for medial meniscus posterior root tears improved the healing of the repaired root and suppressed osteoarthritis progression. Knee Surg Sports Traumatol Arthrosc. 2021;29(4):1258\u0026ndash;68.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHiranaka T, Furumatsu T, Yokoyama Y, et al. The clinical and radiographic outcomes of type 2 medial meniscus posterior root tears following transtibial pullout repair. Knee Surg Sports Traumatol Arthrosc. 2023;31:2323\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYoon KH, Lee W, Park JY. Outcomes of Arthroscopic All-Inside Repair Are Improved Compared to Transtibial Pull-Out Repair of Medial Meniscus Posterior Root Tears. Arthroscopy. 2023;39:1254\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOmae H, Yanagisawa S, Hagiwara K, et al. Arthroscopic pullout repair versus suture anchor repair for medial meniscus posterior root tear combined with high tibial osteotomy. Knee. 2023;45:117\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBachmaier S, Krych AJ, Smith PA, Feucht MJ, LaPrade RF, Wijdicks CA. Biomechanical Performance of Transtibial Pull-Out Posterior Horn Medial Meniscus Root Repair Is Improved With Knotless Adjustable Suture Anchor-Based Fixation. Orthop J Sports Med. 2024;12(4):23259671241239575.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChung KS, Ha JK, Yeom CH, Ra HJ, Jang HS, Choi SH, Kim JG. Comparison of Clinical and Radiologic Results Between Partial Meniscectomy and Refixation of Medial Meniscus Posterior Root Tears: A Minimum 5-Year Follow-up. Arthroscopy. 2015;31(10):1941\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSaengpetch N, Noowan S, Boonrod A, Jaruwanneechai K, Sumanont S, Vijittrakarnrung C. Comparison of medial tibiofemoral joint mechanics between all-suture anchor and transtibial pullout technique for posterior medial meniscal root tears. J Orthop Surg Res. 2023;18(1):591.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSundararajan SR, Ramakanth R, Sethuraman AS, Kannan M, Rajasekaran S. Correlation of factors affecting correction of meniscal extrusion and outcome after medial meniscus root repair. Arch Orthop Trauma Surg. 2022;142(5):823\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMoon HK, Koh YG, Kim YC, Park YS, Jo SB, Kwon SK. Prognostic factors of arthroscopic pull-out repair for a posterior root tear of the medial meniscus. Am J Sports Med. 2012;40(5):1138\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChung KS, Ha JK, Ra HJ, Nam GW, Kim JG. Pullout Fixation of Posterior Medial Meniscus Root Tears: Correlation Between Meniscus Extrusion and Midterm Clinical Results. Am J Sports Med. 2017;45(1):42\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFeucht MJ, K\u0026uuml;hle J, Bode G, Mehl J, Schmal H, S\u0026uuml;dkamp NP, Niemeyer P. Arthroscopic Transtibial Pullout Repair for Posterior Medial Meniscus Root Tears: A Systematic Review of Clinical, Radiographic, and Second-Look Arthroscopic Results. Arthroscopy. 2015;31(9):1808\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTamura M, Furumatsu T, Yokoyama Y, Higashihara N, Kawada K, Ozaki T. Initial tension at suture fixation affects the suture breakage following medial meniscus posterior root repair: A retrospective cohort study. J ISAKOS. 2024;9(3):258\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSt\u0026auml;rke C, Kopf S, Lippisch R, Lohmann CH, Becker R. Tensile forces on repaired medial meniscal root tears. Arthroscopy. 2013;29(2):205\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKawada K, Okazaki Y, Tamura M, Yokoyama Y, Ozaki T, Furumatsu T. Accurate tibial tunnel position in transtibial pullout repair for medial meniscus posterior root tears delays the progression of medial joint space narrowing. Knee Surg Sports Traumatol Arthrosc. 2024;32(8):2023\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKamatsuki Y, Furumatsu T, Hiranaka T, Okazaki Y, Okazaki Y, Kodama Y, Hino T, Masuda S, Miyazawa S, Ozaki T. Placement of an anatomic tibial tunnel significantly improves the medial meniscus posterior extrusion at 90\u0026deg; of knee flexion following medial meniscus posterior root pullout repair. Knee Surg Sports Traumatol Arthrosc. 2021;29(4):1025\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKim KI, Bae JK, Jeon SW, Kim GB. Medial Meniscus Posterior Root Tear Does Not Affect the Outcome of Medial Open-Wedge High Tibial Osteotomy. J Arthroplasty. 2021;36(2):423\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKaratekin YS, Altinayak H. Assessment of Radiological Outcomes of Medial Meniscus Posterior Root Tears Associated With Meniscal Extrusions After Open Wedge High Tibial Osteotomy. Cureus. 2023;15(10):e46884.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNha KW, Lee YS, Hwang DH, Kwon JH, Chae DJ, Park YJ, Kim JI. Second-look arthroscopic findings after open-wedge high tibia osteotomy focusing on the posterior root tears of the medial meniscus. Arthroscopy. 2013;29(2):226\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChoi YS, Chang MJ, Lee JH, Lee JH, D'Lima DD, Kim TW, Chang CB, Kang SB. Repair of medial meniscus posterior root tear is effective for root healing and cartilage regeneration in opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2023;31(12):5799\u0026ndash;811.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKe X, Qiu J, Chen S, Sun X, Wu F, Yang G, Zhang L. Concurrent arthroscopic meniscal repair during open-wedge high tibial osteotomy is not clinically beneficial for medial meniscus posterior root tears. Knee Surg Sports Traumatol Arthrosc.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSeo HS, Lee SC, Jung KA. Second-look arthroscopic findings after repairs of posterior root tears of the medial meniscus. Am J Sports Med. 2011;39(1):99\u0026ndash;107.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLee OS, Lee SH, Lee YS. Comparison of the Radiologic, Arthroscopic, and Clinical Outcomes between Repaired versus Unrepaired Medial Meniscus Posterior Horn Root Tear During Open Wedge High Tibial Osteotomy. J Knee Surg. 2021;34(1):57\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTurgut A, Kayali C, Ağuş H. Radiological analysis of closed-wedge high tibial osteotomy. Eklem Hastalik Cerrahisi. 2012;23(2):82\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLaPrade RF, Oro FB, Ziegler CG, Wijdicks CA, Walsh MP. Patellar height and tibial slope after opening-wedge proximal tibial osteotomy: a prospective study. Am J Sports Med. 2010;38(1):160\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSong GY, Zhang H, Zhang J, Liu X, Xue Z, Qian Y, Feng H. Greater Static Anterior Tibial Subluxation of the Lateral Compartment After an Acute Anterior Cruciate Ligament Injury Is Associated With an Increased Posterior Tibial Slope. Am J Sports Med. 2018;46(7):1617\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWebb JM, Salmon LJ, Leclerc E, Pinczewski LA, Roe JP. Posterior tibial slope and further anterior cruciate ligament injuries in the anterior cruciate ligament-reconstructed patient. Am J Sports Med. 2013;41(12):2800\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJi S, Gao Y, Zhang J, Pan F, Zhu K, Jiang X, Zhou Y. High tibial lateral closing wedge and opening wedge valgus osteotomy produce different effects on posterior tibial slope and patellar height. Front Surg. 2023;10:1219614.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-orthopaedic-surgery-and-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"josr","sideBox":"Learn more about [Journal of Orthopaedic Surgery and Research](http://josr-online.biomedcentral.com)","snPcode":"13018","submissionUrl":"https://submission.nature.com/new-submission/13018/3","title":"Journal of Orthopaedic Surgery and Research","twitterHandle":"@MSKmedBMC","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7840788/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7840788/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eMedial Meniscus Posterior Root Tears (MMPRTs) are known to accelerate medial compartment knee osteoarthritis (OA). This study aimed to evaluate the short-term clinical outcomes of arthroscopic all-suture anchor (ASA) repair combined with high tibial osteotomy (HTO) for patients with medial compartment OA and MMPRTs, offering a potential new surgical approach for this condition.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003e This study retrospectively reviewed patients undergoing arthroscopic ASA repair combined with HTO for medial compartment OA with MMPRTs at our institution between June 2022 and June 2023. All patients underwent second-look arthroscopy during hardware removal. We collected demographic data (age, sex, affected side, duration of symptoms, complications), preoperative and postoperative Tegner activity scores, Lysholm scores, International Knee Documentation Committee (IKDC) scores, and Knee injury and Osteoarthritis Outcome Scores (KOOS). Radiographic comparisons (pre- and post-op) included Kellgren-Lawrence (K-L) grading, hip-knee-ankle angle (HKA), medial proximal tibial angle (mPTA), joint line convergence angle (JLCA), and posterior tibial slope (PTS). Medial meniscus extrusion rate (MMER) was also assessed. At second-look arthroscopy, the healing status of the medial meniscus posterior root was evaluated. Patients were subgrouped based on root healing status to examine correlations with clinical scores, MMER, K-L grade, and symptom duration.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe cohort comprised 30 females (83.3%) and 6 males (16.7%), with a mean age of 59 years. Mean follow-up was 24.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4 months. Significant improvements were observed in all final scores: Lysholm (46.58\u0026thinsp;\u0026plusmn;\u0026thinsp;16.04 to 79.08\u0026thinsp;\u0026plusmn;\u0026thinsp;14.29), IKDC (37.08\u0026thinsp;\u0026plusmn;\u0026thinsp;14.57 to 65.81\u0026thinsp;\u0026plusmn;\u0026thinsp;12.33), KOOS (116.50\u0026thinsp;\u0026plusmn;\u0026thinsp;26.13 to 65.89\u0026thinsp;\u0026plusmn;\u0026thinsp;15.50), and Tegner (1.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.27 to 2.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.15) (all P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Subgroup analysis revealed no significant differences between healed and non-healed groups regarding Lysholm, IKDC, KOOS, Tegner scores, symptom duration, or K-L grade. No complications (infection, nonunion, neurovascular issues) occurred by final follow-up.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eArthroscopic ASA repair combined with HTO significantly improves short-term clinical outcomes in patients with medial compartment OA and MMPRTs. Crucially, the healing status of the medial meniscus posterior root showed no correlation with these short-term clinical outcomes and did not influence the clinical presentation after HTO.\u003c/p\u003e","manuscriptTitle":"Arthroscopic All-in Technique Combined with High Tibial Osteotomy for Osteoarthritis with Posterior Root Tear of the Medial Meniscus","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-30 01:06:57","doi":"10.21203/rs.3.rs-7840788/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-25T03:11:36+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-18T21:06:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"334778850099569060321652121771051717553","date":"2025-11-13T11:49:11+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-23T08:29:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"276362542626323317175164402069085137033","date":"2025-10-23T04:36:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"174930176908703742982575672511504367921","date":"2025-10-19T21:35:16+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-15T09:32:42+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-13T14:14:56+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-13T14:13:43+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Orthopaedic Surgery and Research","date":"2025-10-12T12:54:54+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-orthopaedic-surgery-and-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"josr","sideBox":"Learn more about [Journal of Orthopaedic Surgery and Research](http://josr-online.biomedcentral.com)","snPcode":"13018","submissionUrl":"https://submission.nature.com/new-submission/13018/3","title":"Journal of Orthopaedic Surgery and Research","twitterHandle":"@MSKmedBMC","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e2be2678-ff3b-4484-8df2-a1119d1bab4e","owner":[],"postedDate":"October 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-09T16:20:01+00:00","versionOfRecord":{"articleIdentity":"rs-7840788","link":"https://doi.org/10.1186/s13018-026-06712-8","journal":{"identity":"journal-of-orthopaedic-surgery-and-research","isVorOnly":false,"title":"Journal of Orthopaedic Surgery and Research"},"publishedOn":"2026-02-07 15:57:17","publishedOnDateReadable":"February 7th, 2026"},"versionCreatedAt":"2025-10-30 01:06:57","video":"","vorDoi":"10.1186/s13018-026-06712-8","vorDoiUrl":"https://doi.org/10.1186/s13018-026-06712-8","workflowStages":[]},"version":"v1","identity":"rs-7840788","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7840788","identity":"rs-7840788","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}