Effect of Circumferential Fiber Augmentation Combined with Transtibial Pullout Repair on Medial Meniscal Extrusion in Posterior Root Tears: An Intraoperative Ultrasound-Based Comparative Study

Background A medial meniscal posterior root tear (MMPRT) has a significant impact on knee joint stability, often leading to meniscal extrusion and progressive osteoarthritis (OA). Arthroscopic transtibial pullout repair, the preferred surgical approach for MMPRTs, may be associated with postoperative progression of medial meniscal extrusion (MME), but the results are conflicting. Therefore, the aim of this study was to evaluate the efficacy of a circumferential fiber augmentation (CFA) technique combined with a transtibial pullout repair (TPCFA) in reducing medial meniscal extrusion (MME) compared with that of conventional two simple stitches transtibial pullout repair (TSS). Methods Forty patients with MMPRTs who underwent either TSS (n = 20) or TPCFA (n = 20) were retrospectively analyzed. MME in the TPCFA group was measured intraoperatively using ultrasound imaging at different tension levels of 20 N, 30 N, and 40 N. Because of concerns about suture cutout of the meniscus in the TSS, MME evaluation of the TPCFA group and TSS group was compared under 20 N tension. Results A significant decrease in MME was observed with increasing tension in the TPCFA group, with TPCFA also showing superior reduction in MME compared to TSS under 20 N tension (2.9 ± 0.8 mm vs. 3.4 ± 0.6 mm; P < 0.05). Conclusions This study highlights the potential of the TPCFA technique to reduce meniscal extrusion in MMPRT repair. This is clinically significant as reducing MME can help prevent the progression of OA and improve knee joint stability and function.