Original Article| Volume 25, ISSUE 9, P951-958, September 2009

Arthroscopic Pullout Suture Repair of Posterior Root Tear of the Medial Meniscus: Radiographic and Clinical Results With a 2-Year Follow-up


      This study was undertaken to document the short-term clinical efficacy of arthroscopic pullout suture repair in treating posterior root tears of the medial meniscus.


      From March 2004 to August 2006, 26 patients (27 knees) with posterior root tears of the medial meniscus were treated with arthroscopic pullout suture repair surgery by the senior author. Of these, 20 consecutive patients (21 knees) with a minimum of 2 years' follow-up treated by arthroscopic pullout suture repair were analyzed. Clinical results by use of the Lysholm knee and Hospital for Special Surgery scores and radiographic grade were evaluated, both preoperatively and at final follow-up. In addition, the second-look arthroscopic findings for 10 knees were analyzed.


      A radiographic evaluation using the criteria of Kellgren and Lawrence at final follow-up showed an increase in radiographic grade by 1 grade in only 1 knee. On the second-look arthroscopies performed in 10 knees (47.6%), all repaired menisci had healed completely without additional chondral lesions in the knee. The mean Hospital for Special Surgery scores improved from 61.1 preoperatively to 93.8 at final follow-up (P < .0001), and the mean preoperative Lysholm knee scores improved from 57.0 to 93.1 at final follow-up (P < .0001). Retear was found in 1 knee at the 6-month follow-up, and reoperation was performed with the same procedure used for the index surgery.


      Arthroscopic pullout suture repair is an effective treatment for alleviating meniscal symptoms in patients with a symptomatic posterior root tear of the medial meniscus with degenerated articular cartilage of less than grade III. In addition, no discernable degenerative arthritic changes were found in terms of radiographic features with our limited short-term follow-up.

      Level of Evidence

      Level IV, therapeutic case series.

      Key Words

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        • Pagnani M.J.
        • Cooper D.E.
        • Warren R.F.
        Extrusion of the medial meniscus.
        Arthroscopy. 1991; 7: 297-300
        • Jones A.O.
        • Houang M.T.
        • Low R.S.
        • Wood D.G.
        Medial meniscus posterior root attachment injury and degeneration: MRI findings.
        Australas Radiol. 2006; 50: 306-313
        • Griffith C.J.
        • LaPrade R.F.
        • Fritts H.M.
        • Morgan P.M.
        Posterior root avulsion fracture of the medial meniscus in an adolescent female patient with surgical reattachment.
        Am J Sports Med. 2008; 36: 789-792
        • Allaire R.
        • Muriuki M.
        • Gilbertson L.
        • Harner C.D.
        Biomechanical consequences of a tear of the posterior root of the medial meniscus.
        J Bone Joint Surg Am. 2008; 90: 1922-1931
        • Bin S.I.
        • Kim J.M.
        • Shin S.J.
        Radial tears of the posterior horn of the medial meniscus.
        Arthroscopy. 2004; 20: 373-378
        • Bolano L.E.
        • Grana W.A.
        Isolated arthroscopic partial meniscectomy: Functional radiographic evaluation at 5 years.
        Am J Sports Med. 1993; 21: 432-437
        • Jorgensen U.
        • Sonne-Holm S.
        • Lauridsen F.
        • Rosenklint A.
        Long-term follow-up of meniscectomy in athletes: A prospective longitudinal study.
        J Bone Joint Surg Br. 1987; 69: 80-83
        • Hamada M.
        • Miyama T.
        • Takeyasu Y.
        • Tsutsumi S.
        • Shino K.
        Arthroscopic reduction and internal fixation of an avulsion fracture of the posterior horn of the lateral meniscus.
        Knee Surg Sports Traumatol Arthrosc. 2007; 15: 1510-1513
        • Rangger C.
        • Klestil T.
        • Gloetzer W.
        • Kemmler G.
        • Benedetto K.P.
        Osteoarthritis after arthroscopic partial meniscectomy.
        Am J Sports Med. 1995; 23: 240-244
        • Ozkoc G.
        • Circi E.
        • Gonc U.
        • Irgit K.
        • Pourbagher A.
        • Tandogan R.N.
        Radial tears in the root of the posterior horn of the medial meniscus.
        Knee Surg Sports Traumatol Arthrosc. 2008; 16: 849-854
        • Kellgren J.H.
        • Lawrence J.S.
        Radiological assessment of osteo-arthrosis.
        Ann Rheum Dis. 1957; 16: 485-493
        • Lee S.Y.
        • Jee W.H.
        • Kim J.M.
        Radial tear of the medial meniscal root: Reliability and accuracy of MRI for diagnosis.
        AJR Am J Roentgenol. 2008; 191: 81-85
        • Outerbridge R.E.
        The etiology of chondromalacia patellae.
        J Bone Joint Surg Br. 1961; 43: 752-757
        • Van Dyck P.
        • Gielen J.
        • D'Anvers J.
        • et al.
        MR diagnosis of meniscal tears of the knee: Analysis of error patterns.
        Arch Orthop Trauma Surg. 2007; 127: 849-854
        • Lee Y.G.
        • Shim J.C.
        • Choi Y.S.
        • Kim J.G.
        • Lee J.G.
        • Kim H.K.
        Magnetic resonance imaging findings of surgically proven medial meniscus root tear: Tear configuration and associated knee abnormalities.
        J Comput Assist Tomogr. 2008; 32: 452-457
        • Magee T.
        • Shapiro M.
        • Williams D.
        MR accuracy and arthroscopic incidence of meniscal radial tears.
        Skeletal Radiol. 2002; 31: 686-689
        • Lerer D.B.
        • Umans H.R.
        • Hu M.X.
        • Jones M.H.
        The role of meniscal root pathology and radial meniscal tear in medial meniscal extrusion.
        Skeletal Radiol. 2004; 33: 569-574
        • Chen M.I.
        • Branch T.P.
        • Hutton W.C.
        Is it important to secure the horns during lateral meniscal transplantation?.
        Arthroscopy. 1996; 12: 174-181
        • Bordy J.M.
        • Lin H.M.
        • Hulstyn M.J.
        • Tung G.A.
        Lateral meniscus root tear and meniscus extrusion with anterior cruciate ligament tear.
        Radiology. 2006; 239: 805-810
        • Shino K.
        • Hamada M.
        • Mitsuoka T.
        • Kinoshita H.
        • Toritsuka Y.
        Arthroscopic repair for a flap tear of the posterior horn of the lateral meniscus adjacent to its tibial insertion.
        Arthroscopy. 1995; 11: 495-498
        • Shrive N.G.
        • O'Connor J.J.
        • Goodfellow J.W.
        Load bearing in the knee joint.
        Clin Orthop Relat Res. 1978; : 279-287
        • Marzo J.M.
        • Gurske-Deperio J.
        Effect of medial meniscus posterior horn avulsion and repair on tibiofemoral contact area and peak contact pressure with clinical implications.
        Am J Sports Med. 2009; 37: 124-129
        • Habata T.
        • Uematsu K.
        • Hattori K.
        • Takakura Y.
        • Fujisawa Y.
        Clinical features of the posterior horn tear in the medial meniscus.
        Arch Orthop Trauma Surg. 2004; 124: 642-645
        • DeHaven K.E.
        Meniscus repair.
        Am J Sports Med. 1999; 27: 242-250
        • Cardello P.
        • Gigli C.
        • Ricci A.
        • Chiatti L.
        • Voglino N.
        • Pofi E.
        Retears of postoperative knee meniscus: Findings on magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA) by using low and high field magnet.
        Skeletal Radiol. 2009; 38: 149-156
        • Ahn J.H.
        • Wang J.H.
        • Yoo J.C.
        • Noh H.K.
        • Park J.H.
        A pull out suture for transection of the posterior horn of the medial meniscus: Using a posterior trans-septal portal.
        Knee Surg Sports Traumatol Arthrosc. 2007; 15: 1510-1513
        • Choi N.H.
        • Son K.M.
        • Victoroff B.N.
        Arthroscopic all-inside repair for a tear of posterior root of the medial meniscus: A technical note.
        Knee Surg Sports Traumatol Arthrosc. 2008; 16: 891-893
        • Kim Y.M.
        • Rhee K.J.
        • Lee J.K.
        • Hwang D.S.
        • Yang J.Y.
        • Kim S.J.
        Arthroscopic pullout repair of a complete radial tear of the tibial attachment site of the medial meniscus posterior horn.
        Arthroscopy. 2006; 22 (795.el-795.e4. Available online at
        • Park I.S.
        • Kim S.J.
        New meniscus repair technique for peripheral tears near the posterior tibial attachment of the posterior horn of the medial meniscus.
        Arthroscopy. 2006; 22 (908.el-908.e4. Available online at