title: Arthroscopic Transtibial Pullout Repair for Posterior Medial Meniscus Root Tears: A Systematic Review of Clinical, Radiographic, and Second-Look Arthroscopic Results.
abstract: OBJECTIVE
  To systematically review the results of arthroscopic transtibial pullout repair (ATPR) for posterior medial meniscus root tears.
  
  
  METHODS
  A systematic electronic search of the PubMed database and the Cochrane Library was performed in September 2014 to identify studies that reported clinical, radiographic, or second-look arthroscopic outcomes of ATPR for posterior medial meniscus root tears. Included studies were abstracted regarding study characteristics, patient demographic characteristics, surgical technique, rehabilitation, and outcome measures. The methodologic quality of the included studies was assessed with the modified Coleman Methodology Score.
  
  
  RESULTS
  Seven studies with a total of 172 patients met the inclusion criteria. The mean patient age was 55.3 years, and 83% of patients were female patients. Preoperative and postoperative Lysholm scores were reported for all patients. After a mean follow-up period of 30.2 months, the Lysholm score increased from 52.4 preoperatively to 85.9 postoperatively. On conventional radiographs, 64 of 76 patients (84%) showed no progression of Kellgren-Lawrence grading. Magnetic resonance imaging showed no progression of cartilage degeneration in 84 of 103 patients (82%) and showed reduced medial meniscal extrusion in 34 of 61 patients (56%). On the basis of second-look arthroscopy and magnetic resonance imaging in 137 patients, the healing status was rated as complete in 62%, partial in 34%, and failed in 3%. Overall, the methodologic quality of the included studies was fair, with a mean modified Coleman Methodology Score of 63.
  
  
  CONCLUSIONS
  ATPR significantly improves functional outcome scores and seems to prevent the progression of osteoarthritis in most patients, at least during a short-term follow-up. Complete healing of the repaired root and reduction of meniscal extrusion seem to be less predictable, being observed in only about 60% of patients. Conclusions about the progression of osteoarthritis and reduction of meniscal extrusion are limited by the small portion of patients undergoing specific evaluation (44% and 35% of the study group, respectively).
  
  
  METHODS
  Level IV, systematic review of Level III and IV studies.
authors.affiliation: Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Freiburg, Germany. Electronic address: matthias.feucht@gmx.net.
authors.forename: Matthias J
authors.initials: MJ
authors.lastname: Feucht
authors.affiliation: Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Freiburg, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Kühle
authors.affiliation: Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Freiburg, Germany.
authors.forename: Gerrit
authors.initials: G
authors.lastname: Bode
authors.affiliation: Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Freiburg, Germany.
authors.forename: Julian
authors.initials: J
authors.lastname: Mehl
authors.affiliation: Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Freiburg, Germany.
authors.forename: Hagen
authors.initials: H
authors.lastname: Schmal
authors.affiliation: Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Freiburg, Germany.
authors.forename: Norbert P
authors.initials: NP
authors.lastname: Südkamp
authors.affiliation: Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Freiburg, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Niemeyer
mesh_terms: D001182:Arthroscopy / Q000379:methods; D006801:Humans; D007718:Knee Injuries / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008592:Menisci, Tibial / Q000601:surgery; D017063:Outcome Assessment, Health Care; D011184:Postoperative Period; D024162:Second-Look Surgery; D000070600:Tibial Meniscus Injuries; D014945:Wound Healing