{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T12:12:39Z","timestamp":1788696759060,"version":"build-2803163510"},"reference-count":44,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T00:00:00Z","timestamp":1788652800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T00:00:00Z","timestamp":1788652800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["arthroscopyjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy"],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To determine if medial meniscus extrusion (MME) impacts postoperative alignment and varus correction loss after medial opening\u2010wedge high tibial osteotomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed patients who underwent medial opening\u2010wedge high tibial osteotomy for medial compartment osteoarthritis with \u22655\u2009years of follow\u2010up. Patients were categorized using a 3\u2010mm cutoff for preoperative MME on magnetic resonance imaging (\u22653\u2009mm defined pathological). Serial standing radiographs were obtained preoperatively and at 3\u2009months, 1\u2009year, and \u22655\u2009years postoperatively, and the weight\u2010bearing line (WBL) ratio, hip\u2010knee\u2010ankle angle, mechanical lateral distal femoral angle, medial proximal tibial angle, and joint line convergence angle were evaluated by an independent blinded observer. Alignment changes were analyzed using repeated\u2010measures analysis of variance. Varus correction loss was defined as a final WBL ratio &lt;50%, and predictors were identified using multivariate logistic regression including demographic and radiographic variables. Knee Injury and Osteoarthritis Outcome Score values (mean\u2009\u00b1\u2009standard deviation) were evaluated preoperatively and at the final follow\u2010up. Minimal clinically important difference achievement rates (defined as one\u2010half of the standard deviation of the pre\u2010to\u2010post change) were compared between groups using Fisher's exact tests.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fifty\u2010five knees (44 patients; mean age, 59.3\u2009years; mean follow\u2010up, 6.9 [5.0\u201010.4] years) were included. Forty knees (72.7%) showed pathological MME. The pathological group had a significantly lower final WBL ratio (55.8% vs 65.7%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.008) and hip\u2010knee\u2010ankle (1.9\u00b0 vs 3.9\u00b0,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.025), whereas mechanical lateral distal femoral angle and medial proximal tibial angle did not differ. MME \u22653\u2009mm (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.004), lower 3\u2010month WBL ratio (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u2009.001), and greater preoperative mechanical lateral distal femoral angle (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.005) independently predicted varus correction loss. Knee Injury and Osteoarthritis Outcome Score significantly improved from preoperative to final follow\u2010up in both groups (all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u2009.001). At final follow\u2010up, there were no significant differences between the groups (MME \u22653\u2009mm vs &lt;3\u2009mm): pain, 70.3\u2009\u00b1\u200924.3 vs 73.7\u2009\u00b1\u200925.4 (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.667); symptoms, 70.9\u2009\u00b1\u200922.3 vs 80.7\u2009\u00b1\u200912.3 (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.139); activities of daily living, 76.8\u2009\u00b1\u200922.8 vs 76.7\u2009\u00b1\u200920.4 (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.992); sports, 45.3\u2009\u00b1\u200927.4 vs 53.8\u2009\u00b1\u200921.4 (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.313); and quality of life, 53.2\u2009\u00b1\u200925.8 vs 55.8\u2009\u00b1\u200922.2 (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.751). Minimal clinically important difference achievement rates were lower in the pathological group (57.5%\u201065.0% vs 80.0%\u201086.7%), although not statistically significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Pathological MME was associated with greater varus correction loss despite stable bony alignment and tended to show lower minimal clinically important difference achievement rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level III, retrospective comparative case series.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/arj.70505","type":"journal-article","created":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T11:55:58Z","timestamp":1788695758000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Preoperative Medial Meniscus Extrusion Predicts Varus Correction Loss After 5\u2009Years Despite Stable Bony Alignment After Medial Opening\u2010Wedge High Tibial Osteotomy"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-6937-8515","authenticated-orcid":false,"given":"Kazushi","family":"Horita","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery Sapporo Medical University School of Medicine  Sapporo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3767-7344","authenticated-orcid":false,"given":"Shinichiro","family":"Okimura","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Sapporo Medical University School of Medicine  Sapporo Japan"},{"name":"Department of Orthopaedic Surgery Sapporo Maruyama Orthopedics Hospital  Sapporo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoaki","family":"Kamiya","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Sapporo Medical University School of Medicine  Sapporo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kodai","family":"Hamaoka","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Sapporo Medical University School of Medicine  Sapporo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasutoshi","family":"Ikeda","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Sapporo Medical University School of Medicine  Sapporo 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Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,6]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1302\/0301-620X.83B4.0830513","article-title":"Long\u2010term results of arthroscopic partial lateral meniscectomy in knees without associated damage","volume":"83","author":"Hoser C","year":"2001","journal-title":"J Bone Joint Surg Br."},{"key":"e_1_2_8_3_1","doi-asserted-by":"crossref","first-page":"1549","DOI":"10.1302\/0301-620X.88B12.18140","article-title":"The consequences of meniscectomy","volume":"88","author":"McDermott ID","year":"2006","journal-title":"J Bone Joint Surg Br."},{"key":"e_1_2_8_4_1","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1001\/jama.286.2.188","article-title":"The role of knee alignment in disease progression and functional decline in knee osteoarthritis","volume":"286","author":"Sharma 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measures","volume":"144","author":"Horita K","year":"2024","journal-title":"Arch Orthop Trauma Surg."},{"key":"e_1_2_8_11_1","doi-asserted-by":"crossref","first-page":"2194","DOI":"10.1002\/ksa.12273","article-title":"Surgical strategy and complication management of osteotomy around the painful degenerative varus knee: ESSKA formal consensus part II","volume":"32","author":"Ollivier M","year":"2024","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"e_1_2_8_12_1","doi-asserted-by":"crossref","first-page":"e70007","DOI":"10.1002\/jeo2.70007","article-title":"Joint line convergence angle is the most associated alignment factor with the severity of medial knee osteoarthritis","volume":"11","author":"Tsushima T","year":"2024","journal-title":"J Exp Orthop."},{"key":"e_1_2_8_13_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/978-3-642-59373-4","volume-title":"Principles of deformity correction","author":"Paley 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alignment combined with arthroscopic centralization of medial meniscus in osteoarthritis patients","volume":"36","author":"Katagiri H","year":"2023","journal-title":"J Knee Surg."},{"key":"e_1_2_8_17_1","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1186\/s12891-021-04499-9","article-title":"Effect of concurrent repair of medial meniscal posterior root tears during high tibial osteotomy for medial osteoarthritis during short\u2010term follow\u2010up: A systematic review and meta\u2010analysis","volume":"22","author":"Kyun\u2010Ho S","year":"2021","journal-title":"BMC Musculoskelet Disord."},{"key":"e_1_2_8_18_1","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1007\/s00264-023-05959-8","article-title":"Two years follow\u2010up of patients with knee varus deformity and medial meniscus extrusion after medial opening wedge high tibial osteotomy and arthroscopic meniscus centralization","volume":"48","author":"Wang M","year":"2024","journal-title":"Int Orthop."},{"key":"e_1_2_8_19_1","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1136\/ard.2004.023796","article-title":"Meniscal tear and extrusion are strongly associated with progression of symptomatic knee osteoarthritis as assessed by quantitative magnetic resonance imaging","volume":"64","author":"Berthiaume MJ","year":"2005","journal-title":"Ann Rheum Dis."},{"key":"e_1_2_8_20_1","doi-asserted-by":"crossref","first-page":"17","DOI":"10.2214\/ajr.183.1.1830017","article-title":"Medial meniscus extrusion on knee MRI: Is extent associated with severity of degeneration or type of tear?","volume":"183","author":"Costa CR","year":"2004","journal-title":"AJR Am J Roentgenol."},{"key":"e_1_2_8_21_1","doi-asserted-by":"crossref","first-page":"3124","DOI":"10.1007\/s00167-020-06363-0","article-title":"Medial meniscal extrusion greater than 4 mm reduces medial tibiofemoral compartment contact area: A biomechanical analysis of tibiofemoral contact area and pressures with varying amounts of meniscal extrusion","volume":"29","author":"Debieux P","year":"2021","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"e_1_2_8_22_1","doi-asserted-by":"crossref","first-page":"e22.00019","DOI":"10.2106\/JBJS.RVW.22.00019","article-title":"Meniscal extrusion: A critical analysis review","volume":"10","author":"Kaiser JT","year":"2022","journal-title":"JBJS Rev."},{"key":"e_1_2_8_23_1","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1007\/s00167-019-05701-1","article-title":"Varus alignment increases medial meniscus extrusion and peak contact pressure: A biomechanical study","volume":"28","author":"Willinger L","year":"2020","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"e_1_2_8_24_1","doi-asserted-by":"crossref","first-page":"2617","DOI":"10.1007\/s00167-018-5286-7","article-title":"Alignment factors affecting the medial meniscus extrusion increases the risk of osteoarthritis development","volume":"27","author":"Goto N","year":"2019","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"e_1_2_8_25_1","first-page":"232596712091353","article-title":"Medial opening wedge high tibial osteotomy decreases medial meniscal extrusion and improves clinical outcomes and return to activity","volume":"8","author":"Astur DC","year":"2020","journal-title":"Orthop J Sports Med."},{"key":"e_1_2_8_26_1","doi-asserted-by":"crossref","first-page":"2376","DOI":"10.1177\/0363546520933834","article-title":"Preoperative medial meniscal extrusion is associated with patient\u2010reported outcomes after medial opening wedge high tibial osteotomy","volume":"48","author":"Kim MS","year":"2020","journal-title":"Am J Sports Med."},{"key":"e_1_2_8_27_1","doi-asserted-by":"crossref","first-page":"1614","DOI":"10.1007\/s00167-022-07148-3","article-title":"Increased medial meniscus extrusion led to worse clinical outcomes after medial opening\u2010wedge high tibial osteotomy","volume":"31","author":"Lee CH","year":"2023","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"e_1_2_8_28_1","doi-asserted-by":"crossref","first-page":"316","DOI":"10.2106\/JBJS.21.00456","article-title":"Extent of preoperative medial meniscal extrusion influences intermediate\u2010term outcomes after medial opening\u2010wedge high tibial osteotomy","volume":"104","author":"Yang HY","year":"2022","journal-title":"J Bone Joint Surg Am."},{"key":"e_1_2_8_29_1","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1016\/j.arthro.2022.09.009","article-title":"Medial meniscus posterior root repair restores contact pressure and contact area to its native state even after opening\u2010wedge high tibial osteotomy: A cadaveric biomechanical study","volume":"39","author":"Park HJ","year":"2023","journal-title":"Arthroscopy."},{"key":"e_1_2_8_30_1","doi-asserted-by":"crossref","first-page":"2351","DOI":"10.1177\/03635465211020478","article-title":"Knee joint line obliquity causes tibiofemoral subluxation that alters contact areas and meniscal loading","volume":"49","author":"Wang D","year":"2021","journal-title":"Am J Sports Med."},{"key":"e_1_2_8_31_1","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.arthro.2011.06.034","article-title":"Fractures around the lateral cortical hinge after a medial opening\u2010wedge high tibial osteotomy: A new classification of lateral hinge fracture","volume":"28","author":"Takeuchi R","year":"2012","journal-title":"Arthroscopy."},{"key":"e_1_2_8_32_1","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1097\/00003086-198909000-00035","article-title":"Proximal tibial osteotomy. A new fixation device","volume":"246","author":"Miniaci A","year":"1989","journal-title":"Clin Orthop Relat Res."},{"key":"e_1_2_8_33_1","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.1016\/j.arthro.2021.09.028","article-title":"Insufficient correction and preoperative medial tightness increases the risk of varus recurrence in open\u2010wedge high tibial osteotomy","volume":"38","author":"Song JH","year":"2022","journal-title":"Arthroscopy."},{"key":"e_1_2_8_34_1","first-page":"e622","article-title":"Limb alignment after open\u2010wedge high tibial osteotomy and its effect on the clinical outcome","volume":"34","author":"El\u2010Azab HM","year":"2011","journal-title":"Orthopedics."},{"key":"e_1_2_8_35_1","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/S0968-0160(03)00005-X","article-title":"Regeneration of degenerated articular cartilage after high tibial valgus osteotomy for medial compartmental osteoarthritis of the knee","volume":"10","author":"Koshino T","year":"2003","journal-title":"Knee."},{"key":"e_1_2_8_36_1","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1177\/03635465241313396","article-title":"Association between joint line convergence angle and patient\u2010reported outcomes of opening\u2010wedge high tibial osteotomy","volume":"53","author":"Tsushima T","year":"2025","journal-title":"Am J Sports Med."},{"key":"e_1_2_8_37_1","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/j.arthro.2013.11.028","article-title":"Serial assessment of weight\u2010bearing lower extremity alignment radiographs after open\u2010wedge high tibial osteotomy","volume":"30","author":"Lee YS","year":"2014","journal-title":"Arthroscopy."},{"key":"e_1_2_8_38_1","doi-asserted-by":"crossref","first-page":"311","DOI":"10.5792\/ksrr.18.035","article-title":"Does coronal knee and ankle alignment affect recurrence of the varus deformity after high tibial osteotomy?","volume":"30","author":"Lee OS","year":"2018","journal-title":"Knee Surg Relat Res."},{"key":"e_1_2_8_39_1","doi-asserted-by":"crossref","first-page":"1523","DOI":"10.1016\/j.arthro.2024.07.017","article-title":"Preoperative medial meniscus extrusion on magnetic resonance imaging is associated with a tendency toward varus shifting of open\u2010wedge high tibial osteotomy: A minimum 5\u2010year follow\u2010up study","volume":"41","author":"Song JH","year":"2025","journal-title":"Arthroscopy."},{"key":"e_1_2_8_40_1","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1186\/s40634-020-00283-1","article-title":"Managing intra\u2010articular deformity in high Tibial osteotomy: A narrative review","volume":"7","author":"Micicoi G","year":"2020","journal-title":"J Exp Orthop."},{"key":"e_1_2_8_41_1","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1016\/S0030-5898(20)31922-2","article-title":"Biomechanics of malalignment","volume":"25","author":"Chao EY","year":"1994","journal-title":"Orthop Clin North Am."},{"key":"e_1_2_8_42_1","doi-asserted-by":"crossref","first-page":"2239","DOI":"10.1002\/ksa.12232","article-title":"More than 3\u2009mm of preoperative medial meniscal extrusion is identified as a key risk factor for varus progression in limb alignment after arthroscopic repair of medial meniscus posterior root tear","volume":"32","author":"Yoon KH","year":"2024","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"e_1_2_8_43_1","doi-asserted-by":"crossref","first-page":"e639","DOI":"10.1016\/j.eats.2020.10.051","article-title":"Arthroscopic centralization using knotless anchors for extruded medial meniscus","volume":"10","author":"Koga H","year":"2021","journal-title":"Arthrosc Tech."},{"key":"e_1_2_8_44_1","doi-asserted-by":"crossref","first-page":"103070","DOI":"10.1016\/j.eats.2024.103070","article-title":"Arthroscopic belt capsulodesis using a knotless soft suture anchor for extruded medial meniscus","volume":"13","author":"Nakayama H","year":"2024","journal-title":"Arthrosc Tech."},{"key":"e_1_2_8_45_1","doi-asserted-by":"crossref","first-page":"3041","DOI":"10.1007\/s00167-022-07024-0","article-title":"Osteotomy around the painful degenerative varus knee: A 2022 ESSKA formal consensus","volume":"31","author":"Dawson MJ","year":"2023","journal-title":"Knee Surg Sports Traumatol Arthrosc."}],"container-title":["Arthroscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/arj.70505","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/arj.70505","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/arj.70505","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T11:56:04Z","timestamp":1788695764000},"score":1,"resource":{"primary":{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/10.1002\/arj.70505"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,6]]},"references-count":44,"alternative-id":["10.1002\/arj.70505"],"URL":"https:\/\/doi.org\/10.1002\/arj.70505","archive":["Portico"],"relation":{},"ISSN":["0749-8063","1526-3231"],"issn-type":[{"value":"0749-8063","type":"print"},{"value":"1526-3231","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,6]]},"assertion":[{"value":"2025-07-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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