The Role of Alignment in Treating Meniscus Pathology

Limb alignment correction about the knee joint is crucial for the protection of the meniscus, particularly in the setting of meniscal root repairs and meniscal allograft transplantation. Distal femoral osteotomies and high tibial osteotomies have been described to restore the anatomic alignment to aid in meniscal preservation. This article provides a review of knee alignment and biomechanics, various surgical interventions to correct knee malalignment, and the effect of malalignment on the treatment of meniscal pathology.

Both distal femoral and high tibial corrective osteotomies have been shown to slow the progression of osteoarthritis in the postoperative period. Moreover, corrective osteotomies have resulted in high patient satisfaction and good survival rates at mid- to long-term follow-up in patients with prior varus/valgus malalignment. Ongoing research is aimed to determine the best utilization for concomitant osteotomies in the setting and treatment of meniscal pathology with hopes of decreasing the progression of early-onset osteoarthritis, and ultimately, the conversion to total knee arthroplasty.  Neutral alignment at the level of the knee joint results in optimal force distributions. Corrective valgus and varus osteotomies aim to restore neutral alignment with the goal of ligamentous and meniscal preservation, ideally slowing osteoarthritis progression.