Biomechanical Comparison of Transtibial Pull-out Fixation Versus Suture Anchor Fixation for Repair of Medial Meniscus Posterior Root Tears

BACKGROUND: Posterior medial meniscus root tears are commonly treated with a transtibial pull-out (TO) repair, but significant postoperative meniscal extrusion has been reported. Recently, knotless adjustable suture anchor fixation has been introduced to treat root tears. This anchor-based fixation demonstrates less cyclic displacement than a TO repair. However, it is unknown how meniscal extrusion and contact mechanics compare between these 2 repair techniques when the meniscus endures cyclic tibiofemoral loading. HYPOTHESIS: Suture anchor repair will demonstrate reduced meniscal extrusion and lower medial compartment pressure at the 1000th cycle compared with the TO repair. STUDY DESIGN: Controlled laboratory study. METHODS: tests and repeated-measures analysis of variance with an alpha level set at .05. RESULTS: = .028). No significant differences were found in peak pressures between the 2 repair techniques. CONCLUSION: The suture anchor repair demonstrated lower medial meniscal extrusion and reduced medial compartment contact pressures after time-zero cyclic loading. This biomechanical profile may be important for increasing the likelihood of healing and may translate to improved long-term outcomes for patients undergoing meniscus root repair. CLINICAL RELEVANCE: Understanding the biomechanical differences between repair techniques at time zero may be crucial for optimizing surgical outcomes and minimizing the risk of long-term joint degeneration after meniscus root tears. Future clinical studies should further investigate these findings in live patient populations to validate their effect on root healing, functional outcomes, and long-term osteoarthritis progression.