title: Posterior Meniscal Root Repairs: Outcomes of an Anatomic Transtibial Pull-Out Technique.
abstract: BACKGROUND
  Outcomes after transtibial pull-out repair for posterior meniscal root tears remain underreported, and factors that may affect outcomes are unknown. Purpose/Hypothesis: The purpose of this study was to compare patient-centered outcomes after transtibial pull-out repair for posterior root tears in patients <50 and ≥50 years of age. We hypothesized that improvement in function and activity level at minimum 2-year follow-up would be similar among patients <50 years of age compared with patients ≥50 years and among patients undergoing medial versus lateral root repairs.
  
  
  METHODS
  Cohort study; Level of evidence, 3.
  
  
  METHODS
  Inclusion criteria were patients aged 18 years or older who underwent anatomic transtibial pull-out repair of the medial or lateral posterior meniscus root by a single surgeon. All patients were identified from a data registry consisting of prospectively collected data in a consecutive series. Cohorts were analyzed by age (<50 years [n = 35] vs ≥50 years [n = 15]) and laterality (lateral [n = 15] vs medial [n = 35]). Patients completed a subjective questionnaire preoperatively and at minimum of 2 years postoperatively (Lysholm, Tegner, Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], 12-Item Short Form Health Survey [SF-12], and patient satisfaction with outcome). Failure was defined as revision meniscal root repair or partial meniscectomy.
  
  
  RESULTS
  The analysis included 50 knees in 49 patients (16 females, 33 males; mean age, 38.3 years; mean body mass index, 26.6). Of the 50 knees, 45 were available for analysis. Three of 45 (6.7%) required revision surgery. All failures were in patients <50 years old, and all failures underwent medial root repair. No significant difference in failure was found based on age ( P=.541) or laterality ( P = .544). For age cohorts, Lysholm and WOMAC scores demonstrated significant postoperative improvement. For laterality cohorts, all functional scores significantly improved postoperatively. No significant difference was noted in postoperative Lysholm, WOMAC, SF-12, Tegner, or patient satisfaction scores for the age cohort or the laterality cohort.
  
  
  CONCLUSIONS
  Outcomes after posterior meniscal root repair significantly improved postoperatively and patient satisfaction was high, regardless of age or meniscal laterality. Patients <50 years had outcomes similar to those of patients ≥50 years, as did patients who underwent medial versus lateral root repair. Transtibial double-tunnel pull-out meniscal root repair provided improvement in function, pain, and activity level, which may aid in delayed progression of knee osteoarthritis.
authors.affiliation: The Steadman Philippon Research Institute Vail, Colorado, USA.|The Steadman Clinic, Vail, Colorado, USA.
authors.forename: Robert F
authors.initials: RF
authors.lastname: LaPrade
authors.affiliation: The Steadman Philippon Research Institute Vail, Colorado, USA.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Matheny
authors.affiliation: The Steadman Philippon Research Institute Vail, Colorado, USA.
authors.forename: Samuel G
authors.initials: SG
authors.lastname: Moulton
authors.affiliation: The Steadman Philippon Research Institute Vail, Colorado, USA.
authors.forename: Evan W
authors.initials: EW
authors.lastname: James
authors.affiliation: The Steadman Philippon Research Institute Vail, Colorado, USA.
authors.forename: Chase S
authors.initials: CS
authors.lastname: Dean
mesh_terms: D000293:Adolescent; D000328:Adult; D001182:Arthroscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007718:Knee Injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000175:diagnosis; D063868:Patient Outcome Assessment; D011183:Postoperative Complications / Q000175:diagnosis; D012086:Reoperation; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D000070600:Tibial Meniscus Injuries / Q000601:surgery*; D055815:Young Adult
keywords: lateral meniscus; medial meniscus; outcomes; posterior meniscus root; root repair; transtibial pull-out repair