Medial closing wedge high tibial osteotomy at the time of partial meniscectomy of the discoid lateral meniscus: a finite element analysis

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The discoid lateral meniscus (DLM) is a morphological variant of the lateral meniscus, and partial meniscectomy of the DLM with or without meniscal repair provides favorable clinical outcomes. However, some studies have shown postoperative progression of valgus knee alignment, which will increase the risk of lateral knee osteoarthritis and osteochondral lesions. Medial closing wedge high tibial osteotomy (MCWHTO) during DLM surgery may be a promising surgical strategy to prevent valgus knee alignment following DLM surgery. This study aimed to evaluate the influence of MCWHTO on knee contact stress during partial meniscectomy of the DLM using a finite element analysis (FEA). Subject-specific finite-element models of the knee joint of a patient with DLM were developed using computed tomographic and magnetic resonance images. To evaluate the effect of MCWHTO on knee contact stress, four DLM models were created (the native DLM, and three partially meniscectomized DLMs [preserved width of the meniscus:10 mm, 8 mm, and 6 mm]). In each DLM model, a native knee model and two MCWHTO models (osteotomy wedge angles of 2° and 4°) were created and simulated. Finally, the knee contact stress was evaluated in total of 12 knee models in this study. Greater contact stress was detected in the lateral knee compartment (lateral femoral and tibial cartilage, and lateral meniscus) as the resected volume of the DLM increased without MCWHTO. MCWHTO in addition to partial meniscectomy of the DLM reduced the maximal contact stress in the lateral knee compartment. This is the first biomechanical study to report the influence of MCWHTO on knee contact stress at the time of partial meniscectomy of the DLM. The study findings suggest that the addition of MCWHTO during DLM surgery may be an effective surgical strategy to decrease the risk of postoperative degeneration of the lateral knee cartilage.