Centralization for reducing medial meniscal extrusion after root tear repair appears effective but is...

The aim of this systematic review was to examine whether meniscal centralization techniques, including posteromedial suture anchor (PMA) and posteromedial transtibial pullout repair (PMP), when added to conventional medial meniscus root repair, could affect the outcomes.

A systematic search was conducted in four electronic databases (PubMed, Embase, Scopus, and Web of Science) to identify studies that adopted meniscal reinforcement techniques to reduce the extruded meniscus in patients with pathological root tear and medial meniscal extrusion (MME). The required data, comprising study characteristics, centralization techniques, and outcome measures, were extracted from eligible studies.

A total of 11 studies, including 474 total patients, were identified. Two major techniques were used: PMA (five studies) and PMP (five studies). One study used a combination of both. In terms of clinical scores, MME, and osteoarthritis progression, review of five comparative studies found that all three reported no benefit to using the PMP technique, while both showed significant advantages using the PMA technique. A review of the studies in the PMA group reported significant improvements in MME (range of MME mean difference (MD) -1.2 mm to -0.2 mm). Conflicting results were seen in the PMP group, in which some even showed increased extrusion (range of MME MD -0.50 mm to +1.46 mm). Significant improvements in both PMA and PMP groups were also seen in clinical scores.

This study showed that, compared to isolated root repair, root centralization procedures can result in significant improvement in clinical scores and MME, but the benefits appear dependent on the surgical technique. We identified two predominant techniques, and while both PMA and PMP techniques report improvement in clincal scores, the PMA technique appeared to demonstrate a more consistent reduction in MME.