Study on the effectiveness of arthroscopy for high tibial osteotomy (HTO).

A retrospective study of patients who underwent HTO at the First Affiliated Hospital of Shandong First Medical University from 2018.01-2022.03, and a total of 142 patients were included according to the inclusion and exclusion criteria, of whom 70 (49.3%) were male and 72 (50.7%) were female, with a mean age of 53.62±0.388 years and 168 affected limbs. Patients were divided into two groups (HTO group; HTO combined with arthroscopy group) according to whether they underwent HTO with or without combined arthroscopy. The medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), hip-knee-ankle (HKA) angle, femoral tibial angle (FTA), weight-bearing line (WBL) ratio of the knee joint, opening gap, opening angle, US Hospital for Special Surgery (HSS) score, American Knee Society score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Lysholm score. The effect of arthroscopy in HTO surgery was studied by logistic regression analysis to determine whether arthroscopy is an influential factor in the outcome of HTO surgery.

Both groups of patients with and without HTO combined with arthroscopy showed significant improvement in functional scores and imaging indexes after surgery compared with preoperative scores(Postoperatively, MPTA increased compared to preoperative, JLCA decreased, FTA decreased, HKA angle increased, and WBL% increased; postoperatively, HSS score, KSS score, and Lysholm score increased significantly, and WOMAC score decreased). Multifactorial analysis showed that both arthroscopic and preoperative WOMAC scores were independent influences on the outcome of the procedure, and the probability of Lysholm score being classified as excellent after surgery in the HTO combined arthroscopy group was 4.037 times greater than that in the HTO group postoperatively [OR=4.037, 95% CI: 1.555, 10.480, P=0.004]; each unit increase in preoperative WOMAC score was associated with 0.939 times greater probability of postoperative Lysholm score being classified as excellent [OR=0.939, 95% CI: 0.906, 0.973, P=0.000].

Functional scores and imaging indexes were significantly improved after HTO combined with arthroscopy compared with preoperative scores. Arthroscopic and preoperative WOMAC scores were influential factors in the outcome of HTO surgery; patients with higher preoperative WOMAC scores had poorer postoperative functional recovery of the knee, and patients in the HTO combined arthroscopy group had better postoperative functional scores and functional recovery than those in the non-combined arthroscopy group.