Modified Transtibial Pullout Repair for Medial Meniscus Posterior Root Tear Using a Barbed Suture: A Technical Note

This technical note describes a modified transtibial pullout repair for medial meniscus posterior root tear incorporating a barbed suture to improve fixation strength and load distribution. The technique combines 2 simple sutures placed near the torn root with a circumferential barbed suture passed through the posteromedial meniscocapsular tissue. The barbed suture provides knotless, self-locking fixation that maintains even tension across the construct, enhancing meniscal centralization and reducing extrusion. All sutures are retrieved through a single tibial tunnel and secured on the anterior tibial cortex with knotless anchors. This configuration restores proper tensioning and promotes physiologic hoop stress transmission while minimizing stress concentration and overconstraint. The method is simple, reproducible, and compatible with standard arthroscopic instruments. Moreover, it can be performed in conjunction with centralization or other adjunctive fixation techniques, offering versatility and adaptability for various meniscal root tear patterns.