Medial meniscus posterior root tear repair: An overview of surgical techniques and augmentation strategies

Abstract Purpose Medial meniscus posterior root tears (MMPRTs) disrupt the hoop stress mechanism, leading to increased meniscal extrusion and early osteoarthritis. This systematic review aims to evaluate current surgical techniques for MMPRT repair, including their biomechanical principles, technical aspects and clinical outcomes, with special attention to strategies addressing meniscal extrusion. Methods A systematic search was conducted across PubMed, Scopus and Cochrane Library using Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) 2020 guidelines. Inclusion criteria encompassed studies describing surgical techniques for MMPRT repair published in the last 20 years. Techniques were categorized into pull‐out transtibial repair, suture anchor repair and all‐inside repair. Augmentation procedures were also evaluated. Quality assessment was performed using the Risk of Bias In Non‐randomised Studies of Interventions (ROBINS‐I) tool for comparative studies. Results Forty‐two studies were included. Thirty studies reported on pull‐out transtibial techniques, eight on suture anchor repairs and four on all‐inside repair. Various fixation strategies, suture configurations and devices were described. Biomechanical evidence supports the use of suture anchors for improved cyclic loading performance. Augmentation techniques such as gracilis autografts or centralization sutures were described in select cases to reduce extrusion. Comparative studies suggest that while no single technique guarantees superior healing, suture anchor repair may offer biomechanical advantages over pull‐out repairs. Conclusion Multiple surgical options exist for MMPRT repair, each with specific advantages and limitations. The choice of technique should consider biomechanical integrity, tissue quality and the presence of extrusion. Augmentation strategies may enhance outcomes in selected cases. Further high‐quality comparative studies are needed to define the optimal surgical approach. Level of Evidence Level III, systematic review and meta‐analysis.