Radiologic and Clinical Analysis of Posterior Medial Meniscal Root Tears: A Comparative Study of All-Suture Anchor...

Posterior medial meniscal root (PMMR) tears drastically alter knee biomechanics and reduce degenerative risk from a functional meniscectomy. While transtibial pullout (TTP) is a common repair technique, all-suture anchor (ASA) repair alternatively offers a tunnel-less repair construct. This study aimed to compare the radiologic and clinical outcomes of ASA versus TTP repair techniques in patients with PMMR tears.

The ASA technique would yield superior outcomes compared to the conventional TTP method.

Cohort study; Level of evidence, 3.

This ambidirectional cohort study analyzed patients who underwent repair for isolated PMMR tears between 2018 and 2024. Participants were divided into the ASA and TTP groups with a 1-year follow-up. Radiologic evaluation included magnetic resonance imaging at 9 months and weightbearing radiographs at 1 year postoperatively to assess medial meniscal extrusion (MME), healing status, and cartilage progression according to the International Cartilage Repair Society grading system. Clinical outcomes were assessed concurrently using the International Knee Documentation Committee (IKDC) scores.

The final cohort comprised 36 patients (12 ASAs, 24 TTPs) with comparable baseline characteristics. Radiologically, mean postoperative MME increased in both groups (ASA: 3.63 ± 0.82 mm; TTP: 4.32 ± 1.24 mm), although the difference between groups was not statistically significant (P = .054). Similarly, no significant differences were observed regarding meniscal healing between groups (87.5% vs 66.7%; P = .297) or osteoarthritic cartilage progression. Clinically, both groups achieved significant postoperative IKDC score improvements (P < .05); however, mean improvements were comparable between ASA (20.1) and TTP (20.7) cohorts (P = .859).

Both ASA and TTP techniques significantly improve functional outcomes for repairing PMMR tears with comparable clinical efficacy. While both groups experienced postoperative meniscal extrusion, the ASA technique showed a trend toward better extrusion control, without significant differences in healing rates or osteoarthritic progression. These findings suggest that ASA repair is a viable alternative to the transtibial pullout method.