Objective: Medial meniscus posterior root tears (MMPRTs) disrupt hoop stress transmission and knee biomechanics and are commonly associated with medial meniscus extrusion (MME) and osteoarthritis progression. This study aimed to determine whether adding meniscal centralization to transtibial pull-out posterior root repair improves clinical outcomes and radiographic osteoarthritis severity compared with isolated root repair in patients with MMPRTs.
Materials and Methods: This retrospective comparative study included patients who underwent arthroscopic surgery for MMPRTs and were allocated to either isolated transtibial pull-out root repair or root repair combined with meniscal centralization. Patients with advanced osteoarthritis (Kellgren–Lawrence [K–L] grade ≥3) or varus malalignment >5° were excluded. Clinical outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) subjective score, Lysholm score, and Tegner activity scale. Radiographic evaluation was performed using the K–L grading system on preoperative and postoperative standing radiographs. Between-group comparisons were performed using the independent-samples t-test or Mann–Whitney U test, and within-group comparisons were analyzed using the Wilcoxon signed-rank test.
Results: Twenty patients were included (isolated root repair group, n=10; root repair with meniscal centralization group, n=10). The groups were comparable in age, body mass index, and follow-up duration. Postoperative patient-reported outcome scores were similar between groups for KOOS (78.0±2.6 vs. 79.0±2.1; p=0.356), IKDC (73.2±1.9 vs. 74.0±1.1; p=0.270), Lysholm (89.8±3.1 vs. 90.3±1.8; p=0.666), and Tegner (4.2±0.4 vs. 4.3±0.5; p=0.628). No statistically significant progression in K–L grade was detected within either group, and postoperative K–L grades did not differ significantly between groups.
Conclusion: In patients with MMPRTs without advanced osteoarthritis or marked varus malalignment, the addition of meniscal centralization to posterior root repair did not demonstrate superior short- to mid-term clinical outcomes or radiographic osteoarthritis severity compared with isolated root repair. Larger prospective randomized studies with longer follow-up are needed to better define the indications for meniscal centralization.