What question did this study set out to answer?

The aim was to compare anterior and posterior transtibial approaches for repairing medial meniscal posterior root tears, focusing on outcomes.

March 1, 2026Open Access

Posterior approach achieves more accurate replication of the posterior horn than anterior approach in transtibial pull-out repair of medial meniscus posterior root tear

Key Points

The aim was to compare anterior and posterior transtibial approaches for repairing medial meniscal posterior root tears, focusing on outcomes.
Retrospective analysis of patients undergoing arthroscopic transtibial repair for MMPRT from May 2019 to June 2023.
Tibial tunnel positioning assessed postoperatively via computed tomography.
Healing status evaluated with MRI after one year.
Measurements of medial meniscal extrusion and medial joint space taken pre- and postoperatively.
The posterior approach resulted in more accurate tibial tunnel positioning with a mean absolute distance of 2.8 mm versus 4.9 mm for the anterior approach (p = 0.001).
88.9% of patients achieved complete or partial healing, with no significant difference between the two surgical approaches (p = 0.413).
Medial meniscal extrusion significantly increased postoperatively (p = 0.022), while medial joint space decreased (p = 0.001), without intergroup differences.
Clinical scores improved significantly in all patients, but no significant differences were noted between approaches at follow-up.

Abstract

Abstract Purpose We aimed to compare the anterior and posterior approach for transtibial pull-out repair of medial meniscal posterior root tear (MMPRT) in terms of tibial tunnel positioning of the posterior horn, healing status, medial meniscal extrusion (MME), medial joint space (MJS) narrowing, and clinical outcomes. Methods This retrospective study included patients who underwent arthroscopic transtibial pull-out repair for MMPRT between May 2019 and June 2023. Tibial tunnel positioning was assessed postoperatively using computed tomography. The healing status was evaluated using magnetic resonance imaging (MRI) at the 1-year follow-up visit. Pre- and postoperative MME and MJS widths were measured using MRI and weight-bearing radiography, respectively. Clinical outcomes were assessed preoperatively and at the 2-year follow-up using the International Knee Documentation Committee subjective score, Lysholm score, Knee Injury and Osteoarthritis Outcome Score, and Tegner activity scale. Results A total of 77 patients were initially evaluated for eligibility, of whom 23 were excluded. A total of 54 patients were analyzed (26 anterior approach (AA), 28 posterior approach (PA)). The PA group demonstrated significantly more accurate tibial tunnel positioning compared with the AA group (mean absolute distance: 2.8 ± 2.0 mm versus 4.9 ± 3.2 mm, p = 0.001). MRI at follow-up demonstrated that complete or partial healing was achieved in 88.9% of cases, with no significant difference between groups ( p = 0.413). Overall, MME increased from 3.0 ± 0.9 mm to 4.0 ± 1.6 mm ( p = 0.022) and MJS decreased from 3.5 ± 1.2 mm to 3.1 ± 1.3 mm ( p = 0.001), without intergroup differences. All clinical scores improved significantly from baseline, but no significant differences were observed between approaches at final follow-up. Conclusion The PA group achieved more accurate replication of the posterior horn insertion than the AA group; however, no definitive advantages were observed in short-term clinical or radiographic outcomes. Level of evidence : III, retrospective comparative cohort study.

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Posterior approach achieves more accurate replication of the posterior horn than anterior approach in transtibial pull-out repair of medial meniscus posterior root tear

Key Points

Abstract

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