# Mid-Term Clinical Outcomes of Pullout Repair Combined with Osteochondral Autograft Transplantation for Medial Meniscus Posterior Root Tears with Focal Cartilage Defects: A Treatment-Stratified Cohort Study

## TL;DR

This study examines the effectiveness of combining meniscus repair with cartilage grafts in treating knee injuries, showing promising results compared to other treatments.

## Contribution

The study explores a joint-preserving treatment combining meniscus repair and cartilage grafts for knee injuries.

## Key findings

- Group O showed marked improvement in symptom and pain scores comparable to unicompartmental knee arthroplasty outcomes.
- Mild osteoarthritis progression was observed in Group O radiographically.
- All treatment groups demonstrated postoperative improvement in clinical scores.

## Abstract

Medial meniscus posterior root tears (MMPRTs) with focal cartilage defects present a therapeutic challenge, even in neutral-to-mild varus knees. Although transtibial pullout repair is standard for MMPRTs without advanced osteoarthritis, coexisting cartilage lesions may compromise outcomes and prompt unicompartmental knee arthroplasty (UKA). Combining pullout repair with osteochondral autograft transplantation (OAT) may offer a joint-preserving alternative by restoring meniscal hoop stress and reconstructing focal osteochondral defects. However, supporting evidence is limited. We retrospectively analyzed 150 patients treated surgically for MMPRT between 2015 and 2019, divided into three groups: pullout repair with OAT (Group O, n = 6), pullout repair alone (Group P, n = 120), and UKA (Group U, n = 24), with OAT being applied only in carefully selected patients based on strict clinical and radiographic indications. Clinical outcomes were assessed preoperatively, at 1 year, and at final follow-up (mean, 4.2–5.8 years). The primary outcome was the final clinical score, and secondary outcomes were changes from baseline. All groups improved postoperatively. Group O showed marked improvement in Knee Injury and Osteoarthritis Outcome Score—Symptom and Visual Analogue Scale—Pain score, achieving outcomes comparable to Group U at final follow-up. Group P showed consistent improvement from baseline. Radiographically, mild osteoarthritis progression was observed in Group O. Given the small sample size in Group O and the retrospective design, the findings are exploratory and warrant confirmation in larger prospective studies.