Pes Anserinus and Superficial Medial Collateral Ligament Preserving High Tibial Osteotomy Combined with Arthroscopic Medial Meniscus Root Repair for Medial Compartment Osteoarthritis with Varus Deformity: A Prospective Case Series of 20 Patients

Introduction: Medial compartment osteoarthritis associated with varus malalignment is frequently compounded by medial meniscus root tears, resulting in altered knee biomechanics and accelerated cartilage degeneration. While high tibial osteotomy (HTO) corrects mechanical alignment, medial meniscus root repair restores hoop stress and meniscal function. A combined approach may provide superior biomechanical restoration. Case Series: This prospective case series includes 20 patients with symptomatic medial compartment osteoarthritis, varus deformity, and magnetic resonance imaging-confirmed medial meniscus root tear treated with combined medial opening wedge HTO and arthroscopic root repair using a pes anserinus and superficial medial collateral ligament preserving technique. Results: At a mean follow-up of 20 months, significant improvement was observed in functional outcomes. The Knee Society Score improved from a mean of 52.4 pre-operatively to 88.2 postoperatively, while the Oxford Knee Score improved from 21.8 to 40.2. The mean correction angle achieved was 9.8°, with values extending up to 12-13° in selected patients, and radiological union was achieved in all patients at a mean of 14.2 weeks. Complications were minimal and self-limiting. Conclusion: Combined medial opening wedge HTO with medial meniscus posterior root repair appears to provide satisfactory functional and radiological outcomes in appropriately selected patients.