High tibial osteotomy with individualised alignment and meniscal centralisation improves KOOS sports and recreation and cartilage status compared to conventional Fujisawa-point alignment without centralisation: A propensity score matching study.

Purpose: This study was performed to compare clinical outcomes of medial opening-wedge high tibial osteotomy (MOWHTO) with individualised alignment and medial meniscus centralisation versus conventional alignment targeting the Fujisawa point without centralisation using propensity score matching. It was hypothesised that the individualised approach with centralisation would not be inferior to conventional HTO targeting the Fujisawa point. Methods: This retrospective matched case-control study analysed 161 consecutive knees treated with MOWHTO. After applying uniform exclusion criteria and 1:1 propensity score matching for demographic, radiographic, and meniscal factors, 24 knees with HTO and centralisation and 24 control knees were compared. The centralisation group received individualised alignment based on patient characteristics, targeting a weight-bearing line (WBL) ratio of 57.0%-62.5%, whereas the control group followed the standard 62.5% WBL target. The primary outcome was the Knee Injury and Osteoarthritis Outcome Score (KOOS). The secondary outcomes were radiographic alignment and International Cartilage Repair Society (ICRS) cartilage grade on second-look arthroscopy. Results: The mean follow-up duration was 2.5 ± 0.4 years in the centralisation group and 2.5 ± 0.5 years in the control group. Both groups showed significant improvements in all KOOS subscales from preoperative to final follow-up (all p < 0.01). Final KOOS values were comparable, except for a higher Sports and Recreation score in the centralisation group (72.8 ± 21.1 vs. 56.1 ± 27.5; p = 0.039). Postoperative alignment was more neutral in the centralisation group (WBL ratio 51.9% ± 8.7% vs. 61.4% ± 7.6%; p < 0.001). Improvement in the ICRS grade of the medial femoral condyle was observed in 54.2% of knees in the centralisation group compared with 12.5% in the control group (p = 0.001). Conclusion: MOWHTO with individualised alignment and medial meniscus centralisation achieved clinical outcomes not inferior to conventional alignment targeting the Fujisawa point without centralisation. Level of Evidence: Level III, retrospective cohort study.