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.
- 1Department of Orthopaedic Surgery Yagi Orthopaedic Hospital Sapporo Japan.
- 2Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine Hokkaido University Sapporo Japan.
- 3Centre for Sports Medicine Hokkaido University Hospital Sapporo Japan.
Abstract
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%, p = 0.003; AIS: 48.8% → 68.8%, p < 0.001), with no inter-group difference. No complications occurred in each group. Lysholm scores improved to 96.3 ± 4.5 (TTP) and 92.8 ± 8.1 (AIS), and all Knee Injury and Osteoarthritis Outcome Score subscales improved significantly in both groups, again without inter-group differences.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.
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BibTeX
@article{fujie2026posterior,
title = {{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.}},
author = {Yuki Fujie and Kazunori Yasuda and Koji Yabuuchi and Taku Ebata and Masayuki Inoue and Norimasa Iwasaki and Eiji Kondo},
journal = {Journal of experimental orthopaedics},
year = {2026},
month = oct,
doi = {10.1002/jeo2.70956},
url = {https://europepmc.org/article/MED/42903211},
note = {CC BY},
}
RIS
TY - JOUR
TI - 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.
AU - Yuki Fujie
AU - Kazunori Yasuda
AU - Koji Yabuuchi
AU - Taku Ebata
AU - Masayuki Inoue
AU - Norimasa Iwasaki
AU - Eiji Kondo
PY - 2026
DA - 2026/10/19
JO - Journal of experimental orthopaedics
DO - 10.1002/jeo2.70956
UR - https://europepmc.org/article/MED/42903211
AB - 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%, p = 0.003; AIS: 48.8% → 68.8%, p < 0.001), with no inter-group difference. No complications occurred in each group. Lysholm scores improved to 96.3 ± 4.5 (TTP) and 92.8 ± 8.1 (AIS), and all Knee Injury and Osteoarthritis Outcome Score subscales improved significantly in both groups, again without inter-group differences.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.
SN - 2197-1153
ER -