Treatment of Varus Knee Osteoarthritis in Young Adults by Medial Opening-Wedge High Tibial Osteotomy Combined With Arthroscopic Medial Meniscus Repair

BackgroundVarus malalignment increases load across the medial compartment of the knee and contributes to the progression of medial compartment osteoarthritis and associated meniscal damage.Medial opening-wedge high tibial osteotomy (MOWHTO) can correct lower-limb alignment and unload the medial compartment, while simultaneous meniscal repair may preserve meniscal function in young patients with repairable tears. ObjectiveThe objective of this study is to evaluate changes in pain scores and the short-term radiological and clinical outcomes over six months following medial opening-wedge high tibial osteotomy combined with arthroscopic medial meniscal repair in young adults with varus medial-compartment knee osteoarthritis and repairable medial meniscal tears. MethodsThis prospective case series was conducted in the Department of Orthopaedics at Lata Mangeshkar Hospital, Nagpur, from May 2025 to April 2026.Fifteen patients aged 20-40 years with symptomatic medial compartment knee osteoarthritis, varus alignment, and repairable medial meniscus tears were included.All patients underwent arthroscopic meniscus repair followed by MOWHTO with correction targeted at approximately 50% of the tibial plateau width. ResultsThe mean age of the patients was 33.53±3.46years, and eight (53.3%) were women.At six months, the mean hip-knee-ankle angle was 2.74±0.79°valgus, and the mean weight-bearing-line position was 58.8%±4.8% of the total tibial plateau width measured from the medial edge.The mean medial proximal tibial angle and mechanical lateral distal femoral angle were 91.11±2.04°and 88.05±0.91°,respectively.Mean visual analog scale (VAS) score decreased from 6.87±0.92preoperatively to 3.33±1.05at six weeks, 1.87±0.74at three months, and 0.73±0.88 at six months.The reduction in pain over time was statistically significant (χ²=38.48;p<0.001).During the six-month follow-up, no nonunion, documented delayed union, infection, implant failure, neurovascular injury, thromboembolic event, loss of correction, or reoperation was recorded.No hinge fracture or clinically significant hardware complication was documented.Radiographic follow-up demonstrated maintenance of the achieved correction and osteotomy healing within the follow-up period. ConclusionCombined MOWHTO and arthroscopic medial meniscal repair was associated with improvement in pain scores over six months and postoperative correction of varus alignment.No major complications were recorded in this small case series during the six-month follow-up.Given the absence of a control group and the short follow-up period, these findings should be interpreted as preliminary observations rather than evidence of established effectiveness or safety.