Comparison of Medial Meniscus Root Repair with Two Surgical Techniques Using Medial and Lateral Tunnels: A Prospective Cohort Study

Document Type : RESEARCH PAPER

Authors

1 Department of Orthopedic Surgery, Kerman University of Medical Sciences, Kerman, Iran

2 Clinical Research Development Unit, Mehrgan Hospital, Kerman University of Medical Sciences, Kerman, Iran

10.22038/abjs.2025.86673.3939

Abstract

Objectives: This study aimed to compare the clinical outcomes of trans-tibial pullout repair of the medial meniscus posterior root using the lateral tibial tunnel versus the conventional medial tibial tunnel.
Methods: In this prospective cohort study, patients with posterior root tears of the medial meniscus who underwent surgical repair were divided into two groups based on the tibial tunnel used for fixation: the medial tunnel technique (Group 1) and the lateral tunnel technique (Group 2). The Lysholm score was recorded preoperatively and 12 months postoperatively to assess knee function and the return to daily and sports activities. Demographic data, including age, gender, and associated injuries, were also documented. Statistical analysis was performed using the one-sample t-test, independent t-test, and Pearson correlation.
Results: The mean Lysholm score in the medial tunnel group was 92.67 ± 9.28, while in the lateral tunnel group, it was 88.02 ± 13.59. Statistical analysis revealed no significant difference in the Lysholm scores between the two groups (p > 0.05), indicating comparable clinical outcomes for both techniques.
Conclusion: Both medial and lateral tibial tunnel techniques for trans-tibial pullout repair of the medial meniscus root yield comparable functional outcomes. The choice of tunnel may be guided by anatomical considerations or surgeon preference, as no significant difference was observed in postoperative recovery, as measured by the Lysholm score.
        Level of evidence: II

Keywords

Main Subjects

References

  1. LaPrade CM, Jansson KS, Dornan G, Smith SD, Wijdicks CA, LaPrade RFJJ. Altered tibiofemoral contact mechanics due to lateral meniscus posterior horn root avulsions and radial tears can be restored with in situ pull-out suture repairs. J Bone Joint Surg Am. 2014;96(6):471-9. doi: 10.2106/JBJS.L.01252.
  2. Walker PS, Arno S, Bell C, Salvadore G, Borukhov I, Oh C. Function of the medial meniscus in force transmission and stability. J Biomech. 2015;48(8):1383-8. doi: 10.1016/j.jbiomech.2015.02.055.
  3. Allaire R, Muriuki M, Gilbertson L, Harner CDJJ. Biomechanical consequences of a tear of the posterior root of the medial meniscus: similar to total meniscectomy. J Bone Joint Surg Am. 2008;90(9):1922-31. doi: 10.2106/JBJS.G.00748.
  4. Krych AJ, Johnson NR, Mohan R, Dahm DL, Levy BA, Stuart MJJKS, Sports Traumatology, Arthroscopy. Partial meniscectomy provides no benefit for symptomatic degenerative medial meniscus posterior root tears. Knee Surg Sports Traumatol Arthrosc. 2018;26(4):1117-1122. doi: 10.1007/s00167-017-4454-5.
  5. Krych AJ, Reardon PJ, Johnson NR, et al. Non-operative management of medial meniscus posterior horn root tears is associated with worsening arthritis and poor clinical outcome at 5-year follow-up. Knee Surg Sports Traumatol Arthrosc. 2017;25(2):383-389. doi: 10.1007/s00167-016-4359-8.
  6. Bagherifard, A., et al., Evaluating the Outcome of Meniscus Root Repair Surgery in Patients with Degenerative Meniscus Posterior Root Tears. 2025. The Archives of Bone and Joint Surgery. 13(10): p. 656.
  7. Kawada K, Furumatsu T, Tamura M, et al. Medial joint space narrowing progresses after pullout repair of medial meniscus posterior root tear. Int Orthop. 2023;47(10):2401-2407. doi: 10.1007/s00264-023-05701-4.
  8. LaPrade CM, Foad A, Smith SD, et al. Biomechanical consequences of a nonanatomic posterior medial meniscal root repair. Am J Sports Med. 2015;43(4):912-20. doi: 10.1177/0363546514566191.
  9. Feucht MJ, Kühle J, Bode G, et al.Arthroscopic transtibial pullout repair for posterior medial meniscus root tears: a systematic review of clinical, radiographic, and second-look arthroscopic results. Arthroscopy. 2015;31(9):1808-16. doi: 10.1016/j.arthro.2015.03.022.
  10. Chang PS, Radtke L, Ward P, Brophy RH. Midterm outcomes of posterior medial meniscus root tear repair: a systematic review. Am J Sports Med. 2022;50(2):545-553. doi: 10.1177/0363546521998297.
  11. Eseonu KC, Neale J, Lyons A, Kluzek S. Are outcomes of acute meniscus root tear repair better than debridement or nonoperative management? A systematic review. Am J Sports Med. 2022;50(11):3130-3139. doi: 10.1177/03635465211031250.
  12. Krivicich LM, Kunze KN, Parvaresh KC, et al. Comparison of long-term radiographic outcomes and rate and time for conversion to total knee arthroplasty between repair and meniscectomy for medial meniscus posterior root tears: a systematic review and meta-analysis. Am J Sports Med. 2022;50(7):2023-2031. doi: 10.1177/03635465211017514.
  13. Bernard CD, Kennedy NI, Tagliero AJ, et al. Medial meniscus posterior root tear treatment: a matched cohort comparison of nonoperative management, partial meniscectomy, and repair. Am J Sports Med. 2020;48(1):128-132. doi: 10.1177/0363546519888212.
  14. Faucett SC, Geisler BP, Chahla J, et al. Meniscus root repair vs meniscectomy or nonoperative management to prevent knee osteoarthritis after medial meniscus root tears: clinical and economic effectiveness. Am J Sports Med. 2019;47(3):762-769. doi: 10.1177/0363546518755754.
  15. Becker R, Kopf S, Seil R, Hirschmann MT, Beaufils P, Karlsson J. From meniscal resection to meniscal repair: a journey of the last decade. Knee Surg Sports Traumatol Arthrosc. 2020;28(11):3401-3404. doi: 10.1007/s00167-020-06316-7.
  16. Seil R, Becker R. Time for a paradigm change in meniscal repair: save the meniscus!. Knee Surg Sports Traumatol Arthrosc. 2016;24(5):1421-3. doi: 10.1007/s00167-016-4127-9.
  17. Anderson AF, Irrgang JJ, Dunn W, et al. Interobserver reliability of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification of meniscal tears. Am J Sports Med. 2011;39(5):926-32. doi: 10.1177/0363546511400533.
  18. Kopf S, Beaufils P, Hirschmann MT, et al.Management of traumatic meniscus tears: the 2019 ESSKA meniscus consensus. Knee Surg Sports Traumatol Arthrosc. 2020;28(4):1177-1194. doi: 10.1007/s00167-020-05847-3.
  19. Beaufils P, Becker R, Kopf S, et al. Surgical management of degenerative meniscus lesions: the 2016 ESSKA meniscus consensus. Joints. 2017;5(2):59-69. doi: 10.1055/s-0037-1603813.
  20. Askari, A., et al., Slope of the Medial Tibial Plateau and the Incidence of a Medial Meniscal Tear. The Archives of Bone and Joint Surgery. 2024. 12(11): p. 754.
  21. Bin SI, Kim JM, Shin SJ. Radial tears of the posterior horn of the medial meniscus. Arthroscopy. 2004;20(4):373-8. doi: 10.1016/j.arthro.2004.01.004.
  22. Moon HS, Choi CH, Jung M, Lee DY, Eum KS, Kim SH. Medial meniscal posterior horn tears are associated with increased posterior tibial slope: a case-control study. Am J Sports Med. 2020;48(7):1702-1710. doi: 10.1177/0363546520917420.
  23. Bae JH, Paik NH, Park GW, et al. Predictive value of painful popping for a posterior root tear of the medial meniscus in middle-aged to older Asian patients. Arthroscopy. 2013;29(3):545-9. doi: 10.1016/j.arthro.2012.10.026.
  24. Padalecki JR, Jansson KS, Smith SD, et al. Biomechanical consequences of a complete radial tear adjacent to the medial meniscus posterior root attachment site: In situ pull-out repair restores derangement of joint mechanics. Am J Sports Med. 2014;42(3):699-707. doi: 10.1177/0363546513499314.
  25. Marzo JM, Gurske-DePerio J. Effects of medial meniscus posterior horn avulsion and repair on tibiofemoral contact area and peak contact pressure with clinical implications. Am J Sports Med. 2009;37(1):124-9. doi: 10.1177/0363546508323254.
  26. Kim JH, Chung JH, Lee DH, et al. Arthroscopic suture anchor repair versus pullout suture repair in posterior root tear of the medial meniscus: a prospective comparison study. Arthroscopy. 2011;27(12):1644-53. doi: 10.1016/j.arthro.2011.06.033.
  1. ung WH, Kim DH, Chun CW, Lee JH, Ha JH, Jeong JH. Arthroscopic, suture anchor repair through a novel medial quadriceptal portal for medial meniscal root tear. Knee Surg Sports Traumatol Arthrosc. 2012;20(12):2391-4. doi: 10.1007/s00167-012-1895-8.
  2. Jung YH, Choi NH, Oh JS, Victoroff BN. All-inside repair for a root tear of the medial meniscus using a suture anchor. Am J Sports Med. 2012;40(6):1406-11. doi: 10.1177/0363546512439181.
  3. Feucht MJ, Grande E, Brunhuber J, et al. Biomechanical comparison between suture anchor and transtibial pull-out repair for posterior medial meniscus root tears. Am J Sports Med. 2014;42(1):187-93. doi: 10.1177/0363546513502946.
  4. Cerminara AJ, LaPrade CM, Smith SD, Ellman MB, Wijdicks CA, LaPrade RF. Biomechanical evaluation of a transtibial pull-out meniscal root repair: challenging the bungee effect. Am J Sports Med. 2014;42(12):2988-95. doi: 10.1177/0363546514549447.
  5. Lee DR, Reinholz AK, Till SE, et al. Current reviews in musculoskeletal medicine: Current controversies for treatment of meniscus root tears. Curr Rev Musculoskelet Med. 2022;15(4):231-243. doi: 10.1007/s12178-022-09759-2.
  6. Bhatia S, LaPrade CM, Ellman MB, LaPrade RF. Meniscal root tears: significance, diagnosis, and treatment. Am J Sports Med. 2014;42(12):3016-30. doi: 10.1177/0363546514524162.
  7. Dragoo JL, Konopka JA, Guzman RA, Segovia N, Kandil A, Pappas GP. Outcomes of arthroscopic all-inside repair versus observation in older patients with meniscus root tears. Am J Sports Med. 2020;48(5):1127-1133. doi: 10.1177/0363546520909828.
  8. Vosoughi F, Menbari Oskouie I, Yekaninejad MS, et al. Psychometric Validation of the Persian Version of the Lysholm Score. Orthop J Sports Med. 2025;13(4):23259671251327682. doi: 10.1177/23259671251327682.
  9. Saheta A, Kale S, Chalak A. Tag Archives: Coronal plane deformity. Evaluation. 2024;10(1).
  10. Li J, Shen P, Zou T, et al. Comparison of the effects between arthroscopic transtibial pullout technique and all-inside repair in the treatment of medial meniscus posterior root tears. J Orthop. 2024:65:78-85. doi: 10.1016/j.jor.2024.12.003.
  11. Goes RA, Cruz RS, Pavão DM, et al. Posterior-medial meniscal root repair through lateral tibial tunnel combined with medial opening osteotomy and homologous graft. Arthrosc Tech. 2022;11(7):e1321-e1333. doi: 10.1016/j.eats.2022.03.017.
  12. Nejima S, Kumagai K, Yamada S, et al. Risk of interference between the tibial tunnel and locking screws in medial meniscus posterior root repair and open wedge high tibial osteotomy. J Exp Orthop. 2022;9(1):25. doi: 10.1186/s40634-022-00464-0.
  13. Askari, A., et al., Slope of the Medial Tibial Plateau and the Incidence of a Medial Meniscal Tear. The Archives of Bone and Joint Surgery. 2024. 12(11): p. 754.
  14. Takigami J, Hashimoto Y, Tomihara T, Taniuchi M, Takahashi D, Katsuda H. Combined Procedure of Arthroscopic Pullout Medial Meniscal Root Repair From Lateral Tibia and Open-Wedge Distal Tibial Tubercle Osteotomy. Arthrosc Tech. 2024;13(9):103031. doi: 10.1016/j.eats.2024.103031.

 

 

 

 

 

 

 

 

 

 

The Archives of Bone and Joint Surgery
Volume 14, Issue 1
January 2026
Pages 24-30

Files

History

  • Receive Date: 12 April 2025
  • Revise Date: 12 August 2025
  • Accept Date: 21 June 2025

Share

How to cite

Statistics