# Posterior approach achieves more accurate replication of the posterior horn than anterior approach in transtibial pull-out repair of medial meniscus posterior root tear

## TL;DR

A posterior surgical approach more accurately replicates the meniscus posterior horn insertion compared to an anterior approach, but both approaches show similar healing and clinical outcomes.

## Contribution

The posterior approach provides more accurate tibial tunnel positioning for meniscus repair compared to the anterior approach.

## Key findings

- The posterior approach achieved significantly more accurate tibial tunnel positioning than the anterior approach.
- Both approaches showed similar healing rates and clinical outcomes at follow-up.
- Medial meniscal extrusion and joint space narrowing occurred in both groups without intergroup differences.

## Abstract

We aimed to compare the anterior and posterior approach for transtibial pull-out repair of medial meniscal posterior root tear (MMPRT) in terms of tibial tunnel positioning of the posterior horn, healing status, medial meniscal extrusion (MME), medial joint space (MJS) narrowing, and clinical outcomes.

This retrospective study included patients who underwent arthroscopic transtibial pull-out repair for MMPRT between May 2019 and June 2023. Tibial tunnel positioning was assessed postoperatively using computed tomography. The healing status was evaluated using magnetic resonance imaging (MRI) at the 1-year follow-up visit. Pre- and postoperative MME and MJS widths were measured using MRI and weight-bearing radiography, respectively. Clinical outcomes were assessed preoperatively and at the 2-year follow-up using the International Knee Documentation Committee subjective score, Lysholm score, Knee Injury and Osteoarthritis Outcome Score, and Tegner activity scale.

A total of 77 patients were initially evaluated for eligibility, of whom 23 were excluded. A total of 54 patients were analyzed (26 anterior approach (AA), 28 posterior approach (PA)). The PA group demonstrated significantly more accurate tibial tunnel positioning compared with the AA group (mean absolute distance: 2.8 ± 2.0 mm versus 4.9 ± 3.2 mm, p = 0.001). MRI at follow-up demonstrated that complete or partial healing was achieved in 88.9% of cases, with no significant difference between groups (p = 0.413). Overall, MME increased from 3.0 ± 0.9 mm to 4.0 ± 1.6 mm (p = 0.022) and MJS decreased from 3.5 ± 1.2 mm to 3.1 ± 1.3 mm (p = 0.001), without intergroup differences. All clinical scores improved significantly from baseline, but no significant differences were observed between approaches at final follow-up.

The PA group achieved more accurate replication of the posterior horn insertion than the AA group; however, no definitive advantages were observed in short-term clinical or radiographic outcomes.

Level of evidence: III, retrospective comparative cohort study.