Pullout Repair of Lateral Meniscus Posterior Root Tears Into the Posterolateral Tibial Tunnel During Anterior Cruciate Ligament Reconstruction: Meniscal Healing and Knee Stability

Introduction: To evaluate the impact of concomitant lateral meniscus (LM) posterior horn root tears (LMPHRT) on knee instability in anterior cruciate ligament (ACL) injuries and assess the outcomes of pullout repair into the tibial posterolateral (PL) tunnel.Methods: Fifty-four patients who underwent ACL reconstruction (ACLR) were assessed for characteristics, meniscal repair status, pre-and postoperative clinical scores, side-to-side difference (SSD) in anterior tibial translation, and meniscal healing outcomes one year postoperatively.Statistical analyses were conducted to examine correlations between patient characteristics and SSD and compare SSD between the meniscal repair groups.Patient characteristics, change in SSD (ΔSSD), and clinical scores were compared between the groups with and without LMPHRT repair.Results: Pre-and post-operative SSD did not significantly correlate with patient characteristics.Preoperative SSD was significantly larger in patients with LM (5.0 ± 1.3 vs. 4.0 ± 2.0 mm; p = 0.029) and LMPHRT repair (5.8 ± 1.1 vs. 4.0 ± 1.8 mm; p = 0.005) than in those without.No significant difference was observed in postoperative SSD between patients with and without each meniscal repair.Patients who underwent LMPHRT repair had a notable reduction in ΔSSD compared with those who did not (5.7 ± 1.5 vs. 3.9 ± 2.4 mm; p = 0.049).Among the eight patients, LMPHRT repair achieved complete healing in seven (87.5%) and partial healing in one (12.5%).Conclusion: Concomitant LMPHRT was associated with greater preoperative anterior knee instability in patients with ACL injuries.Following ACLR combined with pullout repair of LMPHRT into the tibial PL tunnel, postoperative anterior stability was comparable to that in patients without LMPHRT who underwent ACLR alone, with favorable meniscal healing at one year.These findings suggest that pullout repair into the tibial PL tunnel may be a viable treatment option for LMPHRT concomitant with ACL injury.