Original surgical technique for patients with medial knee osteoarthritis: short-term and medium-term results

Introduction Knee osteoarthritis (OA) represents a significant challenge in modern orthopedics and can be associated with short-term and long-term disability. Medial knee OA correlates with medial meniscus extrusion, leading to rapid progression of OA.

The objective was to compare surgical outcomes of patients with medial knee OA treated with original and standard methods.

Material and methods Treatment outcomes of 80 patients (44.5 [43.0; 47.0] years) with grade 2 medial knee OA due to medial meniscus damage are reported. The patients were surgically treated using arthroscopic partial meniscus resection (Group 1; n = 20); arthroscopic meniscus centralization (Group 2; n = 20); arthroscopic partial meniscus resection combined with fibular osteotomy (Group 3; n = 20); original technique of arthroscopic meniscus centralization and proximal fibular osteotomy (Group 4; n = 20). Patients were examined preoperatively, at three, six and 12 months of surgery using WOMAC, Lysholm and KOOS grading systems, radiology and MR imaging. The nature of meniscal injury and the extent of meniscal extrusion were evaluated using the WORMS method. Statistical processing of the results was performed using the IBM SPSS Statistics Version 25.0 software package.

Results There were statistically significant differences in the WOMAC, Lysholm, and KOOS scores (p < 0.05) in patients of group 4 and groups 1–3 at 12 months. Statistically significant differences were seen in the WOMAC and Lysholm scores (p > 0.05) in patients of group 3 and group 1 and in Lysholm scores of group 2 (p < 0.05). Statistical differences were recorded in the width of the joint space in the medial knee joint of patients of groups 1, 2 and groups 3, 4, while no differences were found between groups 3 and 4 for this parameter, p > 0.05.

Discussion The effectiveness of the original technique could be caused by the synergistic effect of the two components. Realignment and restored function of the meniscus facilitated normal load distribution, and proximal fibular osteotomy ensured decompression of the medial compartment and the limb realignment with improved function and objective radiographic changes.

Conclusion The original surgical method offered for the treatment of the medial knee OA demonstrated superior results compared to the standard approaches facilitating lasting pain relief, restored knee function and improved quality of life for patients.

1. Belyaeva IB, Mokhov АD, Mokhov DE, Zhugrova ES. Modern methods of non-drug treatment of osteoarthritis of the knee joint. Review of updated national clinical guidelines "Gonarthrosis 2024". Medical alphabet. 2025;(9):28–31. (In Russ.) doi: 10.33667/2078-5631-2025-9-28-31.

2. Giorgino R, Albano D, Fusco S, et al. Knee Osteoarthritis: Epidemiology, Pathogenesis, and Mesenchymal Stem Cells: What Else Is New? An Update. Int J Mol Sci. 2023;24(7):6405. doi: 10.3390/ijms24076405.

3. Priezzheva ES, Sivkova NI, Zhilyakov AV, Volokitina EA. Efficacy of platelet-rich plasma in the treatment of pain syndrome in knee osteoarthritis: a meta-analysis of the studies with a 6-month follow-up. Genij Ortopedii. 2026;32(1):132-143. doi: 10.18019/1028-4427-2026-32-1-132-143.

4. Preobrazhensky PM, Fil AS, Kornilov NN, et al. Current State of Knee Arthroplasty in Russia: Analysis of 36,350 Сases from the Register of the Vreden National Medical Research Center of Traumatology and Orthopedics. Traumatology and Orthopedics of Russia. 2023;29(3):73-85. (In Russ.) doi: 10.17816/2311-2905-9349.

5. Chililov AM, Mikhailova YuV, Zelenova OV, et al. Epidemiology of osteoarthritis in the Russian Federation and incidence prognosis in the period after the COVID-19 pandemic. Social aspects of population health. 2025;71(2):21. (In Russ.) doi: 10.21045/2071-5021-2025-71-2-21.

6. Urazovskaya IL, Miroevskiy FV, Ostapchenko AA, Mansurov DSh. Features of the pathogenesis of osteoarthritis of the hip and knee joints in comorbid pathology (literature review). Russian surgical journal. 2025;1(3):47-56. (In Russ.) doi: 10.18705/3034-7270-2025-1-3-47-56.

7. Peretsmanas EO, Zar VV, Rukin YaA, et al. Microbiological factors in osteoarthritis. Genij Ortopedii. 2025;31(1):129-136. doi: 10.18019/1028-4427-2025-31-1-129-136.

8. Makiev KG, Vasios I, Keskinis A, et al. Meniscus Centralization and Its Effects on Meniscal Extrusion and Knee Biomechanics: A Systematic Review. Sports Med Arthrosc Rev. 2025;33(2):61-68. doi: 10.1097/JSA.0000000000000421.

9. Makiev KG, Vasios IS, Georgoulas P, et al. Clinical significance and management of meniscal extrusion in different knee pathologies: a comprehensive review of the literature and treatment algorithm. Knee Surg Relat Res. 2022;34(1):35. doi: 10.1186/s43019-022-00163-1.

10. Ozeki N, Seil R, Krych AJ, Koga H. Surgical treatment of complex meniscus tear and disease: state of the art. J ISAKOS. 2021;6(1):35-45. doi: 10.1136/jisakos-2019-000380.

11. Swamy N, Wadhwa V, Bajaj G, et al. Medial meniscal extrusion: Detection, evaluation and clinical implications. Eur J Radiol. 2018;102:115-124. doi: 10.1016/j.ejrad.2018.03.007.

12. Oo WM, Linklater JM, Bennell KL, et al. Are OMERACT Knee Osteoarthritis Ultrasound Scores Associated With Pain Severity, Other Symptoms, and Radiographic and Magnetic Resonance Imaging Findings? J Rheumatol. 2021;48(2):270-278. doi: 10.3899/jrheum.191291.

13. Kim JY, Bin SI, Kim JM, et al. Tear gap and severity of osteoarthritis are associated with meniscal extrusion in degenerative medial meniscus posterior root tears. Orthop Traumatol Surg Res. 2019;105(7):1395-1399. doi: 10.1016/j.otsr.2019.09.015.

14. Miromanov AM, Bulikyan HA. A method of surgical treatment of medial osteoarthritis of the knee joint: clinical observation. Polytrauma. 2025;(4):68-71. (In Russ.) doi: 10.24412/1819-1495-2025-4-68-71.

15. Hart HF, Crossley KM, Felson D, et al. Relation of meniscus pathology to prevalence and worsening of patellofemoral joint osteoarthritis: the Multicenter Osteoarthritis Study. Osteoarthritis Cartilage. 2018;26(7):912-919. doi: 10.1016/j.joca.2017.11.017.

16. Perelli S, Conte P, Pizza N, et al. Meniscal extrusion: Proposal for a novel qualitative classification. J Exp Orthop. 2024;12(1):e70126. doi: 10.1002/jeo2.70126.

17. Irzhanski AA, Kulyaba TA, Kornilov NN. Validation and cross-cultural adaptation of rating systems WOMAC, KSS and FJS-12 in patients with knee disorders and injuries. Traumatology and orthopedics of Russia. 2018;24(2):70-79. (In Russ). doi: 10.21823/2311-2905-2018-24-2-70-79.

18. Baranova IV. The use of the functional state of the joints for the estimation of the effectiveness of the application of oxygen/ozone therapy for the rehabilitative treatment of the patients suffering from knee arthritis. Problems of Balneology, Physiotherapy and Exercise Therapy. 2018;95(3):42-48. (In Russ.) doi: 10.17116/kurort201895342.

19. Abed V, Kapp S, Nichols M, et al. Lysholm and KOOS QoL Demonstrate High Responsiveness in Patients Undergoing Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Randomized Clinical Trials. Am J Sports Med. 2024;52(12):3161-3166. doi: 10.1177/03635465231219966.

20. Baranenkov AA, Golozubov OM, Golubev VG, et al. The regional adaptation of KOOS rating scale of the outcomes of knee injuries and diseases. Traumatology and orthopedics of Russia. 2007;(1):26-32. (In Russ.)

21. Mudrov VA. Statistical analysis algorithms of quantitative features in biomedical researchusing the SPSS software package. Transbaikal Medical Bulletin. 2020; (1):140-150. (In Russ.) doi: 10.52485/19986173_2020_1_140.

22. Crawley FP. Declaration of Helsinki: Full paragraph-by-paragraph comparison indicating changes in version 19 October 2024 compared with the most previous version of 19 October 2013. Zenodo. 2024. doi: 10.5281/zenodo.13997192.

23. Dong Y, Yan Y, Zhou J, et al. Evidence on risk factors for knee osteoarthritis in middle-older aged: a systematic review and meta analysis. J Orthop Surg Res. 2023;18(1):634. doi: 10.1186/s13018-023-04089-6.

24. Culvenor AG, Øiestad BE, Hart HF, et al. Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis. Br J Sports Med. 2019;53(20):1268-1278. doi: 10.1136/bjsports-2018-099257.

25. Deichsel A, Peez C, Raschke MJ, et al. Arthroscopic Centralization of the Medial Meniscus Reduces Load on a Posterior Root Repair Under Dynamic Varus Loading: A Biomechanical Investigation. Am J Sports Med. 2024;52(12):3030-3038. doi: 10.1177/03635465241274791.

26. Liew JW, King LK, Mahmoudian A, et al. A scoping review of how early-stage knee osteoarthritis has been defined. Osteoarthritis Cartilage. 2023;31(9):1234-1241. doi: 10.1016/j.joca.2023.04.015.

27. Krych AJ, Lamba A, Wang AS, et al. Nonoperative Management of Degenerative Medial Meniscus Posterior Root Tears: Poor Outcomes at a Minimum 10-Year Follow-up. Am J Sports Med. 2023;51(10):2603-2607. doi: 10.1177/03635465231185132.

28. Krych AJ, Song BM, Nauert RF 3rd, et al. Prospective Consecutive Clinical Outcomes After Transtibial Root Repair for Posterior Meniscal Root Tears: A Multicenter Study. Orthop J Sports Med. 2022;10(2):23259671221079794. doi: 10.1177/23259671221079794.

29. Chung KS, Ha JK, Ra HJ, Kim JG. Preoperative varus alignment and postoperative meniscus extrusion are the main longterm predictive factors of clinical failure of meniscal root repair. Knee Surg Sports Traumatol Arthrosc. 2021;29(12):4122-4130. doi: 10.1007/s00167-020-06405-7.

30. Zhang X, Furumatsu T, Okazaki Y, et al. High body mass index is a risk factor for unfavorable clinical outcomes after medial meniscus posterior root repair in well-aligned knees. J Orthop Sci. 2021;26(3):430-434. doi: 10.1016/j.jos.2020.04.018.

31. Kohno Y, Koga H, Ozeki N, et al. Biomechanical analysis of a centralization procedure for extruded lateral meniscus after meniscectomy in porcine knee joints. J Orthop Res. 2022;40(5):1097-1103. doi: 10.1002/jor.25146.

32. Lee HY, Bin SI, Kim JM, et al. Nonextruded Grafts Result in Better Cartilage Quality After Lateral Meniscal Allograft Transplantation: Quantitative 3-T MRI T2 Mapping. Am J Sports Med. 2023;51(2):404-412. doi: 10.1177/03635465221143373.

33. Melugin HP, Brown JR, Hollenbeck JFM, et al. Increased Posterior Tibial Slope Increases Force on the Posterior Medial Meniscus Root. Am J Sports Med. 2023;51(12):3197-3203. doi: 10.1177/03635465231195841.

34. Krych AJ, Boos AM, Lamba A, Smith PA. Satisfactory Clinical Outcome, Complications, and Provisional Results of Meniscus Centralization with Medial Meniscus Root Repair for the Extruded Medial Meniscus at Mean 2-Year Follow-Up. Arthroscopy. 2024;40(5):1578-1587. doi: 10.1016/j.arthro.2023.10.003.

35. Katagiri H, Nakagawa Y, Miyatake K, et al. Short-Term Outcomes after High Tibial Osteotomy Aimed at Neutral Alignment Combined with Arthroscopic Centralization of Medial Meniscus in Osteoarthritis Patients. J Knee Surg. 2023;36(3):261-268. doi: 10.1055/s-0041-1731738.

36. Wu ZX, Ren WX, Wang ZQ. Proximal fibular osteotomy versus high tibial osteotomy for treating knee osteoarthritis: a systematic review and meta-analysis. J Orthop Surg Res. 2022;17(1):470. doi: 10.1186/s13018-022-03299-8.

37. Pundkar A, Shrivastav S, Chandanwale R, et al. A Systematic Review of the Management of Knee Osteoarthritis by Proximal Fibular Osteotomy in the Indian Population. Cureus. 2024;16(2):e53638. doi: 10.7759/cureus.53638.