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Destabilization of the Medial Meniscus and Cartilage Scratch Murine Model of Accelerated Osteoarthritis
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Posterior root repair versus double-tunnel centralization in medial meniscus root tears: A propensity-matched

Yaşar Samet Gökçeoğlu1, Muhammed Furkan Darılmaz2

  • 1Department of Orthopedics, Sanliurfa Mehmet Akif Inan Training and Research Hospital, Sanliurfa, Turkey.

Journal of Orthopaedic Surgery (Hong Kong)
|February 28, 2026
PubMed

Insights

Second-tunnel centralization for posterior medial meniscus root tears significantly improves patient function and quality of life. This technique offers benefits, especially for patients with varus alignment, without worsening static MRI extrusion.

Area of Science:

  • Orthopedic Surgery
  • Sports Medicine
  • Biomechanical Engineering

Background:

  • Posterior medial meniscus root tears frequently lead to persistent extrusion and altered joint mechanics post-repair.
  • Standard repair techniques may not fully restore normal knee function and joint mechanics.

Purpose of the Study:

  • To compare standard transtibial pull-out repair with a combined approach of repair plus a second-tunnel centralization.
  • To evaluate if the addition of a centralization tunnel improves patient-reported outcomes and structural knee parameters.

Main Methods:

  • A retrospective, two-center cohort study (2019-2024) included adults with MRI-confirmed root tears.
  • Propensity matching created comparable groups (n=96) for repair alone versus repair with centralization.
  • Outcomes included IKDC, KOOS, Lysholm, VAS pain, Tegner activity, and MRI-assessed medial meniscus extrusion at 24 months.

Main Results:

  • The centralization group showed significantly greater improvement in the International Knee Documentation Committee (IKDC) score (+5.7 points; p=0.008).
  • Higher scores were also observed in the Knee Osteoarthritis Outcome Score (KOOS) Quality of Life subscale for the centralization group.
  • Medial meniscus extrusion changes were minimal and comparable between groups; residual extrusion rates were similar (65% vs 62%).

Conclusions:

  • Second-tunnel centralization significantly enhances the likelihood of achieving clinically meaningful functional improvement in patients with posterior medial meniscus root tears.
  • This benefit is observed despite no significant changes in static MRI-measured extrusion, suggesting improved dynamic load-sharing.
  • Centralization is a recommended adjunct, particularly for patients with varus alignment, rather than a routine necessity.
Keywords:
MRIcentralizationlevel IIImedial meniscus posterior root tearmeniscal extrusionpatient-reported outcomespropensity-score matchingretrospective cohort studytranstibial pull-out repairvarus alignment

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