Femoral insertion osteotomy of the lateral collateral ligament for expanding lateral knee space in meniscus repair

To evaluate the technical feasibility, short-term safety, and clinical outcomes of an incomplete osteotomy at the femoral insertion of the lateral collateral ligament (LCL) for expanding a tight lateral compartment during arthroscopic lateral meniscus repair. A single-institution retrospective case series was conducted in patients with lateral meniscus tears and a tight lateral compartment who underwent LCL femoral insertion osteotomy between January 2020 and December 2022. Osteotomy was performed only when standard exposure maneuvers, including the figure-four position, portal adjustment, and gentle varus stress, failed to provide safe visualization and instrument access. The primary outcome was technical success, defined as adequate arthroscopic exposure and completion of the planned meniscal repair. Secondary outcomes included Lysholm score, International Knee Documentation Committee (IKDC) score, Visual Analog Scale (VAS) score for knee pain, osteotomy healing on computed tomography (CT), meniscal healing on magnetic resonance imaging (MRI), and complications. Twenty-five knees were included and followed for 12 months. Adequate exposure of the lateral meniscus and completion of meniscal repair were achieved in all cases. At 12 months, Lysholm, IKDC, and VAS scores improved significantly compared with preoperative values (all P < 0.001). CT at 3 months showed satisfactory osteotomy healing without displacement in all patients. MRI at 12 months demonstrated meniscal healing in 19 patients (76%); the 6 patients who did not meet MRI healing criteria were asymptomatic and did not require reoperation during follow-up. No infection, neurovascular complication, clinically apparent varus instability, loss of reduction, or serious complication was observed. In selected patients with lateral meniscus tears and a tight lateral compartment, arthroscopic repair combined with incomplete osteotomy of the LCL femoral insertion may facilitate exposure and meniscal repair with satisfactory short-term functional recovery. Because this retrospective case series lacked a control group and objective quantification of joint-space widening, the findings should be confirmed in prospective comparative studies with longer follow-up.