Abstract Medial meniscus posterior root tears in the setting of varus malalignment present a difficult clinical pathology, often leading to accelerated medial compartment osteoarthritis if untreated. Both meniscal root repair and high tibial osteotomy remain cornerstones of intervention for these patients, effectively redistributing load and improving joint biomechanics. It remains to be seen whether the unloading effect of high tibial osteotomy or restoration of meniscal hoop stress distribution and reduction of medial meniscal extrusion via root repair provides greater benefit. The addition of arthroscopic meniscal centralization adds a promising tool in reducing medial meniscal extrusion in particular but further clouds the treatment paradigm. Current evidence suggests that while meniscal healing rates and radiographic parameters may improve with combined procedures, patient‐reported outcomes often show no meaningful difference compared with isolated high tibial osteotomy. This disconnect between structural healing and clinical recovery underscores the power of mechanical unloading through osteotomy. Surgeons should therefore weigh the potential advantages of potential meniscal healing against added surgical complexity, cost, and rehabilitation demands.
Andrew Bi (Sun,) studied this question.