Arthroscopic Transtibial Pullout Suture Repair Versus Suture Anchor Repair in Posterior Root Tear of the Medial Meniscus

Arthroscopic Transtibial Pullout Suture Repair Versus Suture Anchor Repair in Posterior Root Tear of the Medial Meniscus: An Open-Label, Blinded-Endpoint, Randomized, Controlled Trial.

The menisci play a fundamental role in maintaining normal knee biomechanics by distributing load, absorbing shock, providing stability, and facilitating joint lubrication. Damage to the meniscus, particularly root tears, disrupts hoop tension and leads to altered joint loading patterns. This condition accelerates cartilage degeneration and predisposes patients to early-onset osteoarthritis, especially when untreated or inadequately managed.

Posterior root medial meniscus tears (PRMMTs) have gained increasing clinical attention in the past two decades. These injuries are biomechanically equivalent to a total meniscectomy because they cause extrusion of the meniscus and loss of its load- sharing capacity. PRMMTs typically affect middle-aged and older patients, often associated with degenerative changes, but can also occur in younger populations following trauma or high-impact activities.

The clinical presentation of PRMMTs is often subtle, with patients experiencing posterior knee pain, mechanical symptoms, and joint line tenderness. Magnetic resonance imaging (MRI) remains the gold standard for diagnosis, with characteristic findings such as the "ghost sign" and meniscal extrusion beyond 3 mm. However, diagnosis is frequently delayed, contributing to the progression of cartilage degeneration by the time of surgical intervention.

Several risk factors have been identified, including female gender, obesity, varus malalignment, and increased posterior tibial slope. These factors not only predispose patients to PRMMTs but also influence the prognosis following surgical repair. Given the high prevalence of these risk factors, especially in populations with rising obesity and osteoarthritis incidence, effective treatment strategies have become essential.

Surgical repair techniques have evolved significantly to restore hoop stresses and improve long-term outcomes. Two widely practiced arthroscopic methods are the transtibial pullout suture repair and the suture anchor repair. Both aim to reattach the meniscal root to its anatomical footprint, thereby restoring biomechanics and delaying degenerative progression.

Study Overview

• Status: Completed
• Conditions: Posterior Root Tear of the Medial Meniscus; Arthroscopic Transtibial Pullout Suture Repair; Suture Anchor Repair
• Intervention / Treatment: Procedure: Arthroscopic Transtibial Pullout Suture Repair; Procedure: Suture Anchor Repair

• Study Type: Interventional
• Enrollment (Actual): 40
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Egypt
  • Giza, Egypt
    • Faculty of Medicine, for Girls, Al-Zhar University, Egpyt

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age between 20 and 50 years, both sexes.
• Acute or degenerative posterior root tear of the medial meniscus confirmed by MRI.
• Isolated medial meniscus root tear or tear associated with anterior cruciate ligament (ACL) injury.
• Willingness to participate and sign informed consent.

Exclusion Criteria:

• Refusal to participate.
• Knee joint malalignment (varus/valgus) confirmed clinically and radiologically.
• Osteoarthritis grade III or IV according to Kellgren-Lawrence classification.
• Irreparable or severely degenerated crushed meniscus.
• Prior ipsilateral knee fracture, infection, or tumor.
• Patients were deemed unfit for surgery or anesthesia.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Arthroscopic Transtibial Pullout Suture Repair	Procedure: Arthroscopic Transtibial Pullout Suture Repair; Patients will have arthroscopic transtibial pullout for their Posterior Root Tear of the Medial Meniscus according to the description in the protocol
Active Comparator: Suture Anchor Repair	Procedure: Suture Anchor Repair; patients will had this procedure according to the description in the protocol

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
subjective functional improvement assessed via the Arabic validated form of the Lysholm score.	The Lysholm score is a 100-point, patient-reported questionnaire evaluating knee ligament and meniscus injury, with higher scores indicating better function. Score of 95-100 indicate excellent function, 84-94 indicate good function, 65-83 indicate fair function, while less than 65 indicates poor function	1 year
subjective functional improvement assessed via the Arabic validated form of the International Knee Documentation Committee 2000 score	The International Knee Documentation Committee 2000 score is a 19-item patient-reported outcome measure scoring symptoms, activity, and function on a 0-100 scale. Higher scores indicate better knee function and fewer symptoms.	1 year

Collaborators and Investigators

• Sponsor: Al-Azhar University

Study record dates

Study Major Dates

• Study Start (Actual): August 23, 2023
• Primary Completion (Actual): March 30, 2025
• Study Completion (Actual): May 30, 2025

Study Registration Dates

• First Submitted: February 3, 2026
• First Submitted That Met QC Criteria: February 10, 2026
• First Posted (Actual): February 13, 2026

Study Record Updates

• Last Update Posted (Actual): February 13, 2026
• Last Update Submitted That Met QC Criteria: February 10, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Other Study ID Numbers: 1971/4-7-2023

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No