Purpose Posterior medial meniscus root tears often cause persistent extrusion and altered joint mechanics despite repair. This study compared standard transtibial pull-out repair with repair plus a second-tunnel centralization, hypothesizing better patient-reported outcomes without major MRI extrusion changes. Methods This retrospective two-center cohort (2019–2024) included adults with MRI-confirmed root tears treated with anatomic repair alone or with an additional centralization tunnel. Propensity matching yielded 96 patients (54 vs 42). The primary endpoint was 24-months change in IKDC score. Secondary outcomes included KOOS subscales, Lysholm, visual analogue scale pain, and Tegner activity. Structural outcomes—medial meniscus extrusion and Meniscal Extrusion Index—were assessed on coronal MRI at 12 ± 4 months. Analyses used ANCOVA adjusted for baseline values, supported by inverse-probability weighting and mixed-effects checks. Results Baseline characteristics were balanced. Extrusion changes were small and similar; residual pathologic extrusion rates were comparable (65% vs 62%). Centralization showed greater IKDC improvement (+5.7 points; p = 0.008) and higher KOOS-Quality of Life. Knees with ≥3 varus demonstrated additional benefit (interaction p = 0.048). Complications were infrequent. Conclusions Second-tunnel centralization significantly increased the probability of achieving clinically meaningful functional improvement , despite unchanged static MRI extrusion . This suggests dynamic load-sharing benefits not captured by static imaging. Therefore, centralization is recommended as a selective adjunct, particularly in varus alignment , rather than a routine necessity.
Gökçeoğlu et al. (Thu,) studied this question.