Concomitant posterior anchoring further reduces posterior meniscal extrusion during pullout repair of medial meniscus posterior root tears: a retrospective study

Purpose
Transtibial pullout repair improves the clinical outcomes of medial meniscus (MM) posterior root tears (PRTs); however, reducing MM extrusion remains challenging. Thus, the purpose of this study was to examine the role of additional posterior anchoring (PA) during pullout repair in reducing the severity of MM extrusion compared to pullout repair alone.

Methods
Patients who underwent pullout repair with two-cinch stitches (TCS) only or TCS combined with PA (TCSPA)-deployment of an additional suture anchor in the posteromedial corner of MM-were included retrospectively. MM medial and posterior extrusion (MMME and MMPE), MM extrusion and remaining volume (MMEV and MMRV), and corresponding ratios were evaluated pre-operatively and three months post-operatively using a three-dimensional meniscal model at 10 degrees and 90 degrees of knee flexion and compared within and between groups.

Results
A total of 15 and 16 patients treated with TCS and TCS-PA, respectively, were enrolled. At 90 degrees knee flexion, both techniques significantly reduced MMPE (TCS: 4.2 +/- 0.7 mm to 3.5 +/- 0.6 mm, p < 0.05; TCS-PA: 3.7 +/- 0.8 mm to 2.8 +/- 0.7 mm, p < 0.05) at three months post-operatively. TCS-PA reduced MMPE more significantly than TCS alone (p < 0.05). Only TCS-PA significantly improved the MMEV and MMRV ratios (39.6 +/- 8.9% to 28.1 +/- 6.0%, p < 0.05 and 60.4 +/- 8.9% to 71.9 +/- 6.0%, p < 0.05, respectively). Significance was not found in all other comparisons.

Conclusions
Both techniques improved MMPE at knee flexion at the three month follow-up, with TCS-PA providing significantly superior results. Our findings support the evidence that the application of PA may be an effective surgical option for alleviating persistent MMPE.

This version of the article has been accepted for publication, after peer review (when applicable) and is subject to Springer Nature’s AM terms of use, but is not the Version of Record and does not reflect post-acceptance improvements, or any corrections. The Version of Record is available online at: http://dx.doi.org/10.1007/s00264-022-05660-2

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