Posterior root repair with high tibial osteotomy improves radiological and clinical outcomes despite greater medial meniscus extrusion: A comparison of transtibial and all-inside techniques.

Purpose: To evaluate whether the transtibial pullout (TTP) or all-inside suture (AIS) technique provides superior radiological and clinical outcomes in patients undergoing medial meniscus posterior root (MMPR) repair combined with high tibial osteotomy (HTO) over a 24- to 48-month follow-up. Methods: This retrospective cohort study analysed 54 knees in 52 patients who underwent MMPR repair with HTO between April 2018 and March 2022. The TTP technique was used until March 2020, after which the AIS technique was performed thereafter. Inclusion criteria were MMPR repair with HTO within 3 months of symptom onset, age 50-70 years, and ≥2 year postoperative follow-up. Exclusion criteria were non-index limb symptoms and unrelated postoperative conditions. Ultimately, 28 knees were assigned to the TTP group and 26 to the AIS group. Radiological, arthroscopic and clinical outcomes were evaluated at a uniform follow-up interval (TTP: 37.1 ± 8.6 months; AIS: 33.8 ± 9.1 months). Medial meniscus extrusion (MME) was quantified using the modified Costa method. Appropriate statistical tests were applied for intra- and inter-group comparisons. Results: The mean ages were 61.7 ± 7.6 years (TTP) and 62.3 ± 8.5 years (AIS). Baseline demographics, osteoarthritis (OA) grades and HTO types showed no significant differences. Postoperative OA grades did not progress significantly. Repair site continuity was restored in 89.3% of the TTP group and 88.5% of the AIS group. MME ratio increased significantly in both groups (TTP: 49.6% → 62.0%, Conclusions: In this patient population, the TTP or AIS techniques performed in conjunction with HTO comparably improved radiological and clinical outcomes at 2-4 years of follow-up despite increased MME. Level of Evidence: Level III prospective cohort study.