Comparison of the therapeutic effects of palliative all-inside suture technique and pull-out reconstruction technique in the treatment of medial meniscus posterior root tear

Comparison of the therapeutic effects of palliative all-inside suture technique and pull-out reconstruction technique in the treatment of medial meniscus posterior root tear | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison of the therapeutic effects of palliative all-inside suture technique and pull-out reconstruction technique in the treatment of medial meniscus posterior root tear Youyue Xu, Zheyuan Shen, Xinhong Zhu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7894659/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 16 You are reading this latest preprint version Abstract Objective: To investigate the clinical efficacy of palliative suture technique that suture the posterior root to the posterior cruciate ligament and pull-out reconstruction technique in the treatment of medial meniscus posterior root tear (MMPRT). Methods: A total of 59 patients with MMPRT who received surgical treatment in our hospital From September 2022 to July 2024 were included in this study, and were divided into the palliative suture group and the Pull-out reconstruction group according to different treatment technique. In the palliative suture group, there were 26cases, 9 males and 17 females, aged 54.49±2.57 years, disease course 7.75±4.75 weeks; In the Pull-out reconstruction group，there were 33 cases, 15 males and 18 females, age of 55.29±2.23 years, disease course 6.46±3.54 weeks. Clinical outcomes were assessed using International Knee Documentation Committee Subjective Knee Form (IKDC) and Lysholm functional questionnaire. The progression of arthritis, meniscus extraction and meniscus healing were evaluated through X-ray and MRI examinations of the knee joint. Results: There was no statistically significant difference in the IKDC score and Lysholm score two years after surgery between two groups (palliative suture group vs pull-out reconstruction group: IKDC score 70.58±2.70 vs 71.03±2.03 p=0.135; Lysholm score: 73.96±4.73 vs 73.21±2.99 p=0.461), And there is no statistical difference in the comparison of each sub-item. There was no statistically significant difference in the incidence two years after surgery between the two groups (palliative suture group vs Pull-out reconstruction group: 76.92% vs 57.58% p=0.083) ; while there was statistically significant difference in the degree of extraction (palliative suture group vs pull-out reconstruction group: 3.75±0.74mm vs 3.33±0.81mm p=0.041). There was no statistically significant difference in the meniscus healing results between the two groups after surgery (palliative suture group vs Pull-out reconstruction group: Complete healing was achieved in 14 cases 53.85%), partial healing in 10 cases 38.46%), and non-healing in 2 cases (7.69%) vs complete healing in 17 cases (51.52%), partial healing in 15 cases (45.45%), and non-healing in 1 case (3.03%), p=0.549). Conclusion: The palliative all-inside suture technique is similar to Pull-out reconstruction in improving knee joint function and imaging outcomes in patients with MMPRT. It is a good supplement to the MMPRT repair techniques. However, considering that the palliative suture method is not an anatomical reconstruction of the posterior root of the medial meniscus, it is not recommended to use this technique as a routine technique for MMPRT repair. medial meniscus posterior root tear meniscal repair all-inside repair Pull-out reconstruction Figures Figure 1 Figure 2 Introduction A medial meniscus posterior root tear (MMPRT) refers to a tear within 1 cm of the meniscal root attachment, or a complete avulsion of the soft tissue or bony structure at the root attachment site. It most commonly occurs in individuals aged 40–50 years and accounts for approximately 3.6% of all meniscal tears [ 1 ] . Once a posterior root tear occurs, the biomechanical alterations are equivalent to those of a meniscectomy [ 2 ] : the hoop tension of the meniscus is lost, the peak contact pressure in the tibiofemoral joint increases, and subsequent stress-induced necrosis of the cartilage and subchondral bone may occur, ultimately leading to osteoarthritis. Conservative treatment and partial meniscectomy have been proven ineffective in managing MMPRT, as they fail to restore the normal structure of the meniscus [ 3 – 5 ] . Therefore, primary surgical repair has become the preferred choice for most surgeons when a repairable MMPRT is encountered. In 2006, Kim et al. [ 6 ] first introduced the pull-out root repair technique, which remains in use today. This method involves reattaching the medial meniscus posterior root to its anatomical insertion site through bone tunnels, aiming to achieve healing between the meniscus and the tibial plateau [ 7 ] . The use of meniscal suturing devices enables end-to-end repair of the torn posterior root, restoring meniscal hoop tension and simplifying the procedure [ 8 , 9 ] . However, this side-to-side suturing approach is suitable only for Laprade type I and some type II injuries [ 10 ] , indicating certain limitations. Another repair technique, which involves suturing the meniscal posterior root to fibers of the posterior cruciate ligament, has been reported in the literature [ 11 – 13 ] , expanding the application of all-inside suturing techniques for MMPRT. Since this method does not effectively restore meniscal function, we refer to it as "palliative suturing." To compare the clinical outcomes of palliative suturing and pull-out root repair in the treatment of MMPRT in elderly patients, we retrospectively reviewed the clinical data of patients who underwent palliative suturing at our hospital and compared the differences in clinical efficacy and imaging findings between the two treatment approaches. Materials and Methods 1.1 Inclusion and Exclusion Criteria Inclusion Criteria : (1) Complete medial meniscus posterior root tear diagnosed via magnetic resonance imaging (MRI) [ 14 ] ; (2) Preoperative Outerbridge grade < 3 [ 15 ] ; (3) Preoperative Kellgren-Lawrence grade (K-L grade) ≤ 2 on radiographs; (4) Age ≥ 60 years; (5) Varus knee deformity ≤ 5°. Exclusion Criteria: (1) Incomplete medical history data; (2) Concomitant injuries (fractures, ligament injuries, or other meniscal injuries); (3) Additional surgical procedures, such as ligament reconstruction, chondroplasty, microfracture, and autologous osteochondral transplantation. 1.2 Clinical Data This study retrospectively reviewed 59 patients who underwent either palliative suturing or pull-out repair for MMPRT at our hospital between July 2021 and July 2023. Among them, 26 patients were treated with the palliative suturing technique. In this group, the mean age was 54.49 ± 2.57 years, with 9 males and 17 females. Twelve cases involved the left knee and 14 the right knee. The mean BMI was 22.53 ± 2.41 kg/m². Regarding trauma history, 7 patients had a history of trauma while 19 did not. The mean symptom duration was 7.75 ± 4.75 weeks. Outerbridge grading was as follows: Grade 0 in 6 cases, Grade 1 in 15 cases, and Grade 2 in 5 cases. The pull-out repair group included 33 patients. Their mean age was 55.29 ± 2.23 years, with 15 males and 18 females. Fourteen cases involved the left knee and 19 the right knee. The mean BMI was 22.19 ± 2.71 kg/m². In terms of trauma history, 12 patients had a history of trauma while 21 did not. The mean symptom duration was 6.46 ± 3.54 weeks. Outerbridge grading was as follows: Grade 0 in 9 cases, Grade 1 in 18 cases, and Grade 2 in 6 cases. No statistically significant differences were observed in the baseline characteristics between the two groups. Details are presented in Table 1 . The study was approved by the institutional ethics committee of The First Affiliated Hospital of Huzhou University, [Ethics (Review) No. 2024KYLL015-02]. Informed consent was waived because of the retrospective design. All experiments were conducted in accordance with the guidelines and regulations of the Helsinki Declaration. Table 1 Comparison of general data of tpatients with posterior root injury of the medial meniscus between two groups Total (N) Age (years) Sex Male/Female Involved Side L/R BMI (kg/m 2 ) Previous Trauma (Yes/No) Duration of Symptoms (weeks) Outerbridge Grade (0/1/2) Palliative Suturing Group 26 53.92 ± 2.29 11/14 12/14 22.07 ± 2.44 7/19 7.38 ± 3.08 6/15/5 Pull-Out Repair Group 33 54.79 ± 2.07 15/18 14/19 22.21 ± 3.00 12/21 7.24 ± 2.76 9/18/6 Statistical Values t = 1.517 χ²=0.058 χ²=0.082 t = 0.186 χ²=0.594 t=-0.186 χ²=1.364 p 0.135 0.809 0.775 0.853 0.441 0.853 0.506 1.3 Treatment Methods 1.3.1 Preoperative Preparation After admission, patients underwent routine blood tests, coagulation studies, preoperative infectious disease screening, weight-bearing anteroposterior and lateral knee radiographs at 45° flexion, MRI of the affected knee, and full-length weight-bearing radiographs of both lower limbs. Surgery was scheduled after exclusion of any surgical contraindications. 1.3.2 Surgical Technique All surgical procedures were performed by two senior sports medicine physicians from the same surgical team. Standard anteromedial and anterolateral portals were established. The anterolateral portal served as the viewing portal for a comprehensive arthroscopic examination of the knee to rule out possible occult injuries in other structures. When visualization of the medial meniscus posterior root was difficult due to a tight medial compartment, the "pie-crusting" technique was applied percutaneously using a 12-gauge needle to release the medial collateral ligament, thereby improving exposure of the medial compartment. Palliative Suturing Group The anterolateral portal was used as the viewing portal and the anteromedial portal as the working portal. Before repair, the tissue structures at the meniscal root attachment site were carefully identified arthroscopically. A meniscal rasp or shaver was then used to debride and freshen the free end of the torn posterior root. After preparing the stump, a meniscal suture device was introduced through the working portal. A stitch was placed on the superior surface of the root stump, 2–3 mm medial to the free edge, performing a vertical mattress suture to secure the posterior root to the fibers of the posterior cruciate ligament (PCL). If the posterior root remained unstable after the first suture, a second suture was placed parallel to the first. After suturing, the stability of the repair was assessed by viewing again through the anteromedial portal while an assistant flexed the knee beyond 90°. A representative case is shown in Fig. 1 . Pull-Out Repair Group The anterolateral portal was used as the viewing portal and the anteromedial portal as the working portal. A shaver was then employed to thoroughly debride the residual tissue at the meniscal posterior root attachment site and to freshen the free edge of the degenerated meniscal tissue. We utilized an anterior cruciate ligament (ACL) tibial tunnel guide as a targeting device, set at an angle of 45°. The dense tissue attachment point of the posterior root served as the intra-articular exit of the bone tunnel, and the anteromedial cortex of the proximal tibia served as the extra-articular exit. A 2.5 mm diameter guide pin was inserted into the tibia, followed by the creation of a 4.5 mm diameter tibial bone tunnel along the guide pin. A #0 high-strength suture (Smith & Nephew) was passed through the free end tissue of the medial meniscus posterior root using a suture passing instrument #2 PDS suture, fixed in a looped configuration. The high-strength suture was then passed through the prepared tibial bone tunnel to the extra-articular side using the pre-placed shuttle suture. Under continuous arthroscopic visualization, with the knee flexed at 90°, the suture was tensioned and secured to the anteromedial tibial cortex using a button plate. After the repair was completed, the stability of the sutured site was assessed again by viewing through the anteromedial portal while an assistant flexed the knee beyond 90°. A representative case is shown in Fig. 2 . 1.3.3 Rehabilitation Protocol Muscle strength training, including quadriceps contractions, straight leg raises, and ankle pump exercises, was initiated immediately after surgery. For the first 3 weeks postoperatively, the affected limb was immobilized in full extension using a brace, and weight-bearing was prohibited. From week 4, knee flexion and extension exercises were started within a 0°–30° range. Between weeks 5 and 10, the range of motion was progressively increased by approximately 15° per week until 120° was achieved. Partial weight-bearing was gradually introduced beginning at week 8, with full weight-bearing permitted 3 months postoperatively. Return to sports activities was allowed no earlier than 6 months after surgery. 1.4.1 Clinical Functional Assessment The same author, who was not involved in the surgical procedures, assessed knee function using the Lysholm score and the International Knee Documentation Committee (IKDC) subjective knee evaluation form. Assessments were conducted preoperatively and at the 2-year postoperative follow-up. 1.4.2 Imaging Evaluation Radiographs Weight-bearing anteroposterior (AP) radiographs of the affected knee at 45° flexion, lateral radiographs, and full-length weight-bearing radiographs of both lower limbs were obtained. The Kellgren-Lawrence (K-L) grading system [ 16 ] was used to assess the severity of osteoarthritis. The full-length weight-bearing radiographs were utilized to evaluate lower limb alignment. Magnetic Resonance Imaging (MRI) MRI was used to diagnose medial meniscus posterior root tears, assess the progression of meniscal extrusion, and evaluate the healing status of the repaired root. The "truncated triangle sign" on coronal images and the "ghost meniscus sign" on sagittal images were considered characteristic MRI findings for diagnosing MMPRT. Focal cartilage lesions in the medial femoral condyle and medial tibial plateau were graded on preoperative and postoperative MRI scans according to the International Cartilage Repair Society (ICRS) classification system [ 17 ] . Meniscal extrusion distance was specifically defined as the distance, measured on coronal images at the midpoint of the medial femoral condyle from initial and final MRI scans, between the outer edge of the medial tibial plateau and the outer edge of the medial meniscus along a vertical line [ 18 ] . Postoperative healing of the posterior root was classified into three grades based on MRI appearance: complete healing (continuity observed in all three planes: sagittal, coronal, and axial), partial healing (loss of continuity in any one or two planes), and non-union/re-tear (loss of continuity in all planes) [ 4 ] . All patients underwent the corresponding radiographic and MRI examinations both preoperatively and at the final follow-up. 1.5 Statistical Analysis Statistical analysis was performed using SPSS software (SPSS 24.0, IBM Inc., Chicago, Illinois, United States). A p-value < 0.05 was considered statistically significant. Categorical data, such as gender, affected side, trauma history, intergroup comparisons of meniscal extrusion, and intragroup comparisons before and after treatment, were analyzed using the chi-square test. Intergroup comparisons of preoperative Outerbridge grade, Kellgren-Lawrence (K-L) grade, MRI cartilage injury grade, and meniscal healing degree, as well as their intragroup comparisons before and after treatment, were analyzed using Fisher's exact test. For continuous quantitative data, such as age, BMI, symptom duration, follow-up time, meniscal extrusion distance, Lysholm score, and IKDC score, normality was first assessed. Data conforming to a normal distribution are presented as mean ± standard deviation (X̄ ± S) and were compared between groups using the independent samples t-test. Data not conforming to a normal distribution are presented as median (25th percentile, 75th percentile) (Md (P25, P75)) and were compared between groups using the Mann-Whitney U test (rank-sum test). Intragroup comparisons of continuous data before and after surgery were performed using the paired samples t-test for normally distributed data and the Wilcoxon signed-rank test (paired samples rank-sum test) for non-normally distributed data. 2.1 Functional Outcomes No statistically significant differences were observed in the total or individual domain scores of the IKDC between the two groups either preoperatively or at the 2-year postoperative follow-up (P > 0.05). Similarly, comparison of the total Lysholm scores between the two groups preoperatively and at 2 years postoperatively showed no statistically significant differences (P > 0.05). There were also no statistically significant differences in the individual item scores of the Lysholm scale (P > 0.05). Details are presented in Tables 2 and 3 . Table 2 Comparison of IKDC scores of patients with posterior root injury of the medial meniscus between two groups before operation and 2 years after operation Group n Clinical Symptoms Athletic Activities Function Total Score Preoperative 2-Year Postoperative Follow-up Preoperative 2-Year Postoperative Follow-up Preoperative 2-Year Postoperative Follow-up Preoperative 2-Year Postoperative Follow-up Palliative Suturing Group 26 23.61 ± 0.86 27.88 ± 1.49 12.19 ± 2.10 35.27 ± 2.41 2.85 ± 1.15 7.19 ± 0.40 38.31 ± 3.82 70.58 ± 2.70 Pull-Out Repair Group 33 23.50 ± 1.58 28.35 ± 1.05 12.67 ± 1.67 35.43 ± 2.37 3.21 ± 1.05 7.30 ± 0.47 39.48 ± 2.92 71.03 ± 2.03 Test Value t = 0.329 t=-1.35 t = 0.987 t = 0.987 t = 1.269 t = 0.961 t = 1.342 t = 0.735 P < 0.01 0.125 0.095 0.285 0.918 0.051 0.069 0.135 Table 3 Comparison of Lysholm scores of patients with posterior root injury of the medial meniscus between two groups before operation and 2 years after operation Group n Limp Support Locking Preoperative 2-Year Postoperative Follow-up Preoperative 2-Year Postoperative Follow-up Preoperative 2-Year Postoperative Follow-up Palliative Suturing Group 26 3.92 ± 1.01 4.15 ± 1.01 4.08 ± 1.41 5.00 ± 0.00 6.92 ± 2.35 14.23 ± 1.84 Pull-Out Repair Group 33 4.09 ± 1.01 3.79 ± 0.99 3.82 ± 1.49 5.00 ± 0.00 6.73 ± 1.86 14.39 ± 1.66 Test Value t = 0.631 t=-1.397 t=-0.678 t=-0.358 t = 0.358 P 0.918 0.667 0.177 0.134 0.478 Group n Instability Pain Swelling Preoperative 2-Year Postoperative Follow-up Preoperative 2-Year Postoperative Follow-up Preoperative 2-Year Postoperative Follow-up Palliative Suturing Group 26 10(10,10) 20(20,20) 7.88 ± 2.52 13.65 ± 4.13 6(6,6) 6(6,6) Pull-Out Repair Group 33 10(10,10) 20(20,20) 7.27 ± 2.53 12.58 ± 2.54 6(6,6) 6(6,6) Test Value Z=-1.265 Z=-0.554 t=-0.924 t=-1.233 Z=-0.513 Z=-1.678 P 0.206 0.580 0.637 < 0.001 0.093 0.093 Group n Stair Climbing Squatting Lysholm score Preoperative 2-Year Postoperative Follow-up Preoperative 2-Year Postoperative Follow-up Preoperative 2-Year Postoperative Follow-up Palliative Suturing Group 26 6(2,6) 6(6,6) 4(4,4) 4.5(4,5) 45.23 ± 4.36 73.96 ± 4.73 Pull-Out Repair Group 33 6(6,6) 6(6,6) 4(4,4) 4(4,4) 45.55 ± 4.27 73.21 ± 2.99 Test Value Z=-0.702 Z=-0.170 Z=-0.411 Z=-1.043 t = 0.278 t=-0.742 P 0.483 0.865 0.681 0.297 0.782 0.461 2.2 Imaging Outcomes A statistically significant difference was observed in the preoperative Kellgren-Lawrence grade, cartilage injury grade, presence of meniscal extrusion, and extent of extrusion when compared within each group before and after surgery (P < 0.05). However, no statistically significant differences were found between the two groups at the 2-year postoperative follow-up regarding Kellgren-Lawrence grade, cartilage injury grade, presence of meniscal extrusion, or meniscal healing status (P > 0.05). Notably, a statistically significant difference was detected in the extent of postoperative meniscal extrusion between the groups (Palliative Suturing vs. Pull-Out Repair: 3.75 ± 0.74 mm vs. 3.33 ± 0.81 mm; p = 0.041). Table 4 Comparison of imaging indexes of patients with posterior root injury of the medial meniscus between two groups before operation and 2 years after operation Group n Kellgren-Lawrence Grade (0/1/2) Cartilage Injury Grade (0/1/2) Meniscal Extrusion (Yes/No) Extent of Meniscal Extrusion(mm) Meniscal Healing (Complete/Partial/Non-union) Preoperative 2-Year Postoperative Follow-up Test Value P Preoperative 2-Year Postoperative Follow-up Test Value P Preoperative 2-Year Postoperative Follow-up Test Value P Preoperative 2-Year Postoperative Follow-up Test Value P Palliative Suturing Group 26 13/11/2 10/13/3 χ²=0.72 0.698 12/10/4 6/15/5 χ²=3.12 0.21 13/13 20/6 χ²=4.17 0.041 3.177 ± 0.763 3.75 ± 0.74 t=-0.830 < 0.01 14/10/2 Pull-Out Repair Group 33 18/10/5 14/14/5 χ²=1.57 0.456 13/15/5 12/14/7 χ²=0.56 0.756 17/16 19/14 χ²=055 0.458 3.167 ± 1.045 3.33 ± 0.81 t=-1.115 0.038 17/15/1 Test Value χ²=1.56 χ²=0.42 χ²=0.37 χ²=2.08 χ²=0.02 χ²=3.01 t=-0.042 t=-2.086 χ²=1.20 P 0.458 0.811 0.831 0.354 0.888 0.083 0.967 0.041 0.549 2.3 Complications In the pull-out repair group, one patient developed postoperative incisional redness, swelling, and discharge. The infection was successfully resolved after intravenous administration of cefuroxime and regular wound dressing changes. No other patients in either group required revision surgery or underwent knee arthroplasty during the follow-up period. Discussion 3.1 Advantages and Limitations of Traditional MMPRT Repair Techniques An MMPRT alters the mechanical environment of the medial compartment of the knee, accelerating the progression of knee osteoarthritis. Therefore, root repair surgery is generally recommended once the diagnosis is confirmed [ 3 – 5 ] . Traditional root repair techniques include the pull-out repair and the all-inside side-to-side suturing technique. Although studies have confirmed the therapeutic efficacy of these repair procedures, each technique has certain limitations, which may prevent some patients with MMPRT from receiving optimal treatment [ 6 – 10 ] . The pull-out repair is a classic technique for posterior root restoration, capable of anatomically reconstructing the torn meniscal root tissue and restoring the normal anatomical configuration of the meniscus. However, this method presents the following limitations in clinical practice: (1) It requires specific instruments to establish the tibial tunnel, resulting in longer operative time and greater tissue trauma; (2) In patients with concomitant osteoporosis, there is a risk of postoperative failure due to suture cut-through and subsequent loosening; (3) Histological studies suggest that after tibial tunnel healing, issues such as incomplete histological integration and reduced biomechanical strength at the meniscus-bone interface may occur [ 19 ] . Compared to the pull-out transosseous repair technique, the all-inside side-to-side suture technique offers advantages such as being less invasive, technically less demanding, and eliminating the need for tibial tunnel drilling. Studies have confirmed that its biomechanical strength is comparable to that of the pull-out reconstruction [ 8 , 20 ] . Furthermore, clinical research suggests that anatomic all-inside side-to-side suturing can achieve superior clinical outcomes compared to pull-out reconstruction [ 21 ] , making it one of the promising future directions in MMPRT treatment. However, in practical application, we have observed that this method still presents the following limitations: (1) It is only applicable to Laprade type I and II injuries [ 9 , 10 ] ; (2) It requires sufficient residual meniscal tissue on the tibial side for adequate suture anchor fixation. To preserve the benefits of the all-inside technique while expanding its indications and clinical applications, researchers have proposed a repair technique that involves suturing the meniscal posterior root to the fibers of the posterior cruciate ligament [ 11 – 13 ] . 3.2 Differences in Functional Outcomes, Imaging Findings, and Meniscal Extrusion Between Palliative All-Inside Suturing and Pull-Out Repair for MMPRT (1) Functional Outcomes : The recovery of knee function is the most intuitive indicator for evaluating treatment efficacy. Our study found no statistically significant difference in the improvement of knee function between palliative all-inside suturing and pull-out repair. Whether through all-inside palliative suturing or pull-out repair, most patient symptoms can be significantly alleviated once the posterior root structure is stably fixed. However, patients should be informed preoperatively that symptoms caused by pre-existing joint degeneration cannot be improved by root repair alone. (2) Imaging Findings : No significant progression of knee degeneration was observed at 2 years postoperatively in either the palliative all-inside suturing group or the pull-out repair group. This suggests that the palliative suturing technique can partially restore the mechanical environment of the medial compartment, thereby delaying the progression of knee osteoarthritis. The overall healing rate (complete + partial healing) of the posterior root was 92.31% (24/26) in the palliative all-inside suturing group and 95.97% (32/36) in the pull-out repair group, which is generally consistent with previous studies [ 10 ] . Although numerically slightly lower in the palliative group, statistical analysis confirmed no significant difference. Thus, posterior root healing after palliative suturing does not appear to be a particular concern. (3) Meniscal Extrusion : Meniscal extrusion increases both the mean and peak contact pressures in the tibiofemoral joint and is one of the predictors of osteoarthritis progression. In our study, neither palliative suturing nor pull-out repair halted meniscal extrusion, and the degree of extrusion was more severe in the palliative suturing group (3.75 ± 0.74 mm vs. 3.33 ± 0.81 mm; p = 0.041). The lack of significant difference in postoperative Kellgren-Lawrence grading between groups may be attributed to multiple factors. First, the absolute difference in the increase of postoperative extrusion was relatively small (0.57 mm in the palliative group vs. 0.15 mm in the pull-out group), potentially resulting in minimal changes in local stress. Second, this study represents a mid-term follow-up of 2 years, which may be insufficient for the mechanical changes to manifest as significant cartilage wear or osteoarthritis progression. Confirming differences between the techniques may require incorporating more osteoarthritis-related imaging parameters and longer follow-up periods. While the short-term efficacy of meniscal centralization has been demonstrated [ 24 , 25 ] , its long-term impact on osteoarthritis remains to be further investigated. We also plan to explore the application of palliative suturing combined with meniscal centralization in future studies. 3.3 Research Background and Technical Characteristics of the Palliative Suturing Technique Anatomical studies have shown that the center of the medial meniscus posterior root is located 8.2 ± 0.7 mm from the superior edge of the tibial insertion of the posterior cruciate ligament (PCL) in cadaveric specimens [ 22 ] . Therefore, suturing the posterior root to the PCL has been proposed as an alternative when side-to-side repair is not feasible for MMPRT. Biomechanical studies have confirmed that this repair method can restore tibiofemoral contact area, contact pressure, and peak pressure to levels comparable to those of an intact knee. Sun et al. [ 12 , 13 ] reported in their retrospective study that suturing the meniscal posterior root to the PCL fibers improved clinical function, radiological outcomes, cartilage degeneration, and meniscal extrusion progression. Jiang [ 11 ] also confirmed the clinical efficacy of the palliative suturing technique. In addition to sharing the general advantages of all-inside techniques, palliative suturing is specifically suitable for cases where the residual meniscal tissue on the tibial side is insufficient for side-to-side all-inside repair. However, since this technique does not anatomically reconstruct the meniscal hoop structure, it may not fully restore the biomechanical environment of the medial compartment. Therefore, its long-term impact on the progression of osteoarthritis remains unclear. Based on this limitation, the authors do not recommend palliative suturing as a routine choice for MMPRT repair. Conclusion The palliative all-inside suturing technique yields similar outcomes to pull-out repair in terms of functional improvement and radiological results for patients with MMPRT, making it a valuable supplementary option for posterior root repair. However, given that this technique does not achieve anatomical reconstruction of the medial meniscus posterior root, it is not recommended as a routine treatment for MMPRT. Declarations Conflict of Interest: All authors declare no conflict of interest. Funding: The authors received no funding for this work. Authors and Affiliations Xu Youyue 1,2 , Shen Zheyuan 1,2 , Zhu Xinhong (corresponding author) 1,2 1. The First Affiliated Hospital of Huzhou University , The First People's Hospital of Huzhou, Department of Orthopedics, Huzhou 313000，Zhejiang, China; 2. Huzhou Key Laboratory for Early Diagnosis and Treatment of Osteoarthritis, Huzhou 313000，Zhejiang, China Author Contributions: Xu Youyue was responsible for patient follow-up, data registration, and manuscript writing; Shen Zheyuan was responsible for study design, statistical analysis, and data verification; Zhu Xinhong was responsible for manuscript review. Corresponding author: Zhu Xinhong, E-mail: [email protected] Ethics approval and consent to participate The study was approved by the institutional ethics committee of The First Affiliated Hospital of Huzhou University, [Ethics (Review) No. 2024KYLL015-02]. All experiments were conducted in accordance with the guidelines and regulations of the Helsinki Declaration. Every human participant in the study declares their informed consent to participate in the study. Publication of clinical datasets we are bound by the strict data privacy policies of our institution, The First Affiliated Hospital of Huzhou University, and ethical regulations governing patient confidentiality. We can provide further clarification on the data collection and processing methods upon request to ensure the study is thoroughly understood. Please contact the corresponding author at [email protected] . Consent to Participate Obtain informed consent from all participants in the study. Consent for publication Not Applicable References LaPrade CM, James EW, Cram TR, Feagin JA, Engebretsen L, LaPrade RF. Meniscal root tears: a classification system based on tear morphology. Am J Sports Med. 2015;43(2):363–9. LaPrade CM, Foad A, Smith SD, et al. Biomechanical consequences of a nonanatomic posterior medial meniscal root repair. Am J Sports Med. 2015;43(4):912–20. Krivicich LM, Kunze KN, Parvaresh KC, et al. 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Non-Anatomical Arthroscopic All-Inside Repair of Medial Meniscus Posterior Root Tear to Posterior Cruciate Ligament for Patients with Normal Lower Limb Alignment. Orthop Surg. 2022;14(2):397–404. Su J, Wan H, Pang Y, et al. Trans-Posterior Cruciate Ligament All-Inside Root Repair Versus Partial Meniscectomy for Medial Meniscus Posterior Root Tears: Comparison of Semiquantitative and Quantitative MRI Outcomes in Cartilage Degeneration and Osteoarthritic Progression. Cartilage. 2022;13(3):19476035221114242. Su J, Wan H, Pang Y, et al. Clinical, Radiographic, and MRI Evaluation of All-Inside Medial Meniscus Posterior Root Repair via Suture Fixation to the Posterior Cruciate Ligament Versus Partial Meniscectomy: Results at 3-Year Follow-up. Orthop J Sports Med. 2023;11(7):23259671231180545. Choi SH, Bae S, Ji SK, Chang MJ. The MRI findings of meniscal root tear of the medial meniscus: emphasis on coronal, sagittal and axial images. Knee Surg Sports Traumatol Arthrosc. 2012;20(10):2098–103. Krych AJ, Johnson NR, Mohan R, et al. Arthritis Progression on Serial MRIs Following Diagnosis of Medial Meniscal Posterior Horn Root Tear. J Knee Surg. 2018;31(7):698–704. KELLGREN JH, LAWRENCE JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16(4):494–502. Brittberg M, Winalski CS. Evaluation of cartilage injuries and repair. J Bone Joint Surg Am 2003 85-A Suppl 2: 58–69. Choi CJ, Choi YJ, Lee JJ, Choi CH. Magnetic resonance imaging evidence of meniscal extrusion in medial meniscus posterior root tear. Arthroscopy. 2010;26(12):1602–6. Deng XH, Wang JS, Chen Z et al. Incomplete Histologic Healing and Diminished Biomechanical Strength of Meniscus-Bone Interface After Medial Meniscus Posterior Root Transosseous Repair in a Goat Model. Arthroscopy. 2024: S0749-8063(24)00552-8 [pii]. Vertullo CJ, Cadman J, Dabirrahmani D, Appleyard R. Biomechanical Comparison of an All-Inside Meniscal Repair Device Construct Versus Pullout Sutures for Arthroscopic Transtibial Repair of Posterior Medial Meniscus Root Tears: A Matched-Pair Cadaveric Study. Orthop J Sports Med. 2021;9(4):23259671211000464. Yoon KH, Lee W, Park JY. Reprint of: Outcomes of Arthroscopic All-Inside Repair Are Improved Compared to Transtibial Pull-Out Repair of Medial Meniscus Posterior Root Tears. Arthroscopy. 2023;39(6):1376–83. Johannsen AM, Civitarese DM, Padalecki JR, Goldsmith MT, Wijdicks CA, LaPrade RF. Qualitative and quantitative anatomic analysis of the posterior root attachments of the medial and lateral menisci. Am J Sports Med. 2012;40(10):2342–7. Chung KS, Ha JK, Ra HJ, Kim JG. A meta-analysis of clinical and radiographic outcomes of posterior horn medial meniscus root repairs. Knee Surg Sports Traumatol Arthrosc. 2016;24(5):1455–68. Chung KS, Ha JK, Ra HJ, Nam GW, Kim JG. Pullout Fixation of Posterior Medial Meniscus Root Tears: Correlation Between Meniscus Extrusion and Midterm Clinical Results. Am J Sports Med. 2017;45(1):42–9. Chernchujit B, Prasetia R. Arthroscopic direct meniscal extrusion reduction: surgical tips to reduce persistent meniscal extrusion in meniscal root repair. Eur J Orthop Surg Traumatol. 2018;28(4):727–34. Additional Declarations No competing interests reported. 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Shen","email":"","orcid":"","institution":"湖州师范学院附属第一医院","correspondingAuthor":false,"prefix":"","firstName":"Zheyuan","middleName":"","lastName":"Shen","suffix":""},{"id":539635755,"identity":"528d1247-ed39-46ee-8b78-eb4db2c7d142","order_by":2,"name":"Xinhong Zhu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0klEQVRIiWNgGAWjYBACNv7mA4f/VPyz42c4fIA4LXwSxxIf8Jw5kCzZeCyBOC1yDDnKBrwtBxg3NJ8xINJhDGfYJCQb7jAbsJ35eOMNg52cbgMhLcy9xyQMdzzjM+c5u9lyDkOysdkBgracS5NIPMPMbDnj7DZpHoYDidsIa8kxkzjYxsy44f6bZ0RrMTZsbDvMuOHAGTYitQAD+THDmbRkyYZjxpZzDIjwi3w/MCoZKmxAUfnwxpsKOzmCWlCABA+RUYOshVQdo2AUjIJRMCIAACPqR+J1TjqBAAAAAElFTkSuQmCC","orcid":"","institution":"湖州师范学院附属第一医院","correspondingAuthor":true,"prefix":"","firstName":"Xinhong","middleName":"","lastName":"Zhu","suffix":""}],"badges":[],"createdAt":"2025-10-18 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07:09:13","extension":"xml","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":105372,"visible":true,"origin":"","legend":"","description":"","filename":"9e6959b34c8a4956a47e65e6b8257fa91structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7894659/v1/f8d615210fbe190ee3fe55b6.xml"},{"id":95894646,"identity":"94bbfe25-c4bb-4736-b8e4-68294d712cbb","added_by":"auto","created_at":"2025-11-14 07:09:12","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":116933,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7894659/v1/87327aa6afb3a7e67446ba58.html"},{"id":95894641,"identity":"392f296e-8183-4582-8e08-3b81c57b01bd","added_by":"auto","created_at":"2025-11-14 07:09:12","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":736669,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA 59-year-old male with the medial meniscus posterior root tear of his right knee ①Preoperative full weight X-ray of both lower extremities ② Red thin arrow ：complete root tear ③ red thick arrow： \"ghost sign\" ④ Red thin line： the medial meniscus extruction ⑤Pull-out technique repair ⑥ Yellow arrow: healed posterior meniscus root; The yellow thin line： the medial meniscus extraction ⑦postoperative function\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7894659/v1/4fdba864729b60d1dc50fae9.png"},{"id":96242692,"identity":"0d3df931-d5c1-4e3c-9b1e-b48fecb0ad02","added_by":"auto","created_at":"2025-11-19 07:14:04","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":701672,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA 57-year-old female with the medial meniscus posterior root tear of her left knee ① Preoperative full weight X-ray of both lower extremities ② Red thin arrow ：complete root tear ③ red thick arrow： \"ghost sign\" ④ Red thin line： the medial meniscus extruction ⑤Pull-out technique repair ⑥ Yellow arrow: healed posterior meniscus root; The yellow thin line： the medial meniscus extraction ⑦postoperative function\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7894659/v1/4c896052f580149bdc4dcb72.png"},{"id":96452768,"identity":"201a3e96-f112-4dcf-adb0-639b97c03478","added_by":"auto","created_at":"2025-11-21 09:43:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3742083,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7894659/v1/5998bb6f-02a4-4e0d-9589-51383467e381.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of the therapeutic effects of palliative all-inside suture technique and pull-out reconstruction technique in the treatment of medial meniscus posterior root tear","fulltext":[{"header":"Introduction","content":"\u003cp\u003eA medial meniscus posterior root tear (MMPRT) refers to a tear within 1 cm of the meniscal root attachment, or a complete avulsion of the soft tissue or bony structure at the root attachment site. It most commonly occurs in individuals aged 40\u0026ndash;50 years and accounts for approximately 3.6% of all meniscal tears \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Once a posterior root tear occurs, the biomechanical alterations are equivalent to those of a meniscectomy \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e: the hoop tension of the meniscus is lost, the peak contact pressure in the tibiofemoral joint increases, and subsequent stress-induced necrosis of the cartilage and subchondral bone may occur, ultimately leading to osteoarthritis.\u003c/p\u003e\u003cp\u003eConservative treatment and partial meniscectomy have been proven ineffective in managing MMPRT, as they fail to restore the normal structure of the meniscus \u003csup\u003e[\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Therefore, primary surgical repair has become the preferred choice for most surgeons when a repairable MMPRT is encountered. In 2006, Kim et al. \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e first introduced the pull-out root repair technique, which remains in use today. This method involves reattaching the medial meniscus posterior root to its anatomical insertion site through bone tunnels, aiming to achieve healing between the meniscus and the tibial plateau \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. The use of meniscal suturing devices enables end-to-end repair of the torn posterior root, restoring meniscal hoop tension and simplifying the procedure \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. However, this side-to-side suturing approach is suitable only for Laprade type I and some type II injuries \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e, indicating certain limitations. Another repair technique, which involves suturing the meniscal posterior root to fibers of the posterior cruciate ligament, has been reported in the literature \u003csup\u003e[\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e, expanding the application of all-inside suturing techniques for MMPRT. Since this method does not effectively restore meniscal function, we refer to it as \"palliative suturing.\" To compare the clinical outcomes of palliative suturing and pull-out root repair in the treatment of MMPRT in elderly patients, we retrospectively reviewed the clinical data of patients who underwent palliative suturing at our hospital and compared the differences in clinical efficacy and imaging findings between the two treatment approaches.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e1.1\u0026ensp;Inclusion and Exclusion Criteria\u003c/h2\u003e\u003cp\u003e\u003cb\u003eInclusion Criteria\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e(1)\u0026ensp;Complete medial meniscus posterior root tear diagnosed via magnetic resonance imaging (MRI) \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e;\u003c/p\u003e\u003cp\u003e(2)\u0026ensp;Preoperative Outerbridge grade\u0026thinsp;\u0026lt;\u0026thinsp;3 \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e;\u003c/p\u003e\u003cp\u003e(3)\u0026ensp;Preoperative Kellgren-Lawrence grade (K-L grade)\u0026thinsp;\u0026le;\u0026thinsp;2 on radiographs;\u003c/p\u003e\u003cp\u003e(4)\u0026ensp;Age\u0026thinsp;\u0026ge;\u0026thinsp;60 years;\u003c/p\u003e\u003cp\u003e(5)\u0026ensp;Varus knee deformity\u0026thinsp;\u0026le;\u0026thinsp;5\u0026deg;.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eExclusion Criteria:\u003c/h3\u003e\n\u003cp\u003e(1)\u0026ensp;Incomplete medical history data;\u003c/p\u003e\u003cp\u003e(2)\u0026ensp;Concomitant injuries (fractures, ligament injuries, or other meniscal injuries);\u003c/p\u003e\u003cp\u003e(3)\u0026ensp;Additional surgical procedures, such as ligament reconstruction, chondroplasty, microfracture, and autologous osteochondral transplantation.\u003c/p\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e1.2 Clinical Data\u003c/h2\u003e\u003cp\u003eThis study retrospectively reviewed 59 patients who underwent either palliative suturing or pull-out repair for MMPRT at our hospital between July 2021 and July 2023. Among them, 26 patients were treated with the palliative suturing technique. In this group, the mean age was 54.49\u0026thinsp;\u0026plusmn;\u0026thinsp;2.57 years, with 9 males and 17 females. Twelve cases involved the left knee and 14 the right knee. The mean BMI was 22.53\u0026thinsp;\u0026plusmn;\u0026thinsp;2.41 kg/m\u0026sup2;. Regarding trauma history, 7 patients had a history of trauma while 19 did not. The mean symptom duration was 7.75\u0026thinsp;\u0026plusmn;\u0026thinsp;4.75 weeks. Outerbridge grading was as follows: Grade 0 in 6 cases, Grade 1 in 15 cases, and Grade 2 in 5 cases.\u003c/p\u003e\u003cp\u003eThe pull-out repair group included 33 patients. Their mean age was 55.29\u0026thinsp;\u0026plusmn;\u0026thinsp;2.23 years, with 15 males and 18 females. Fourteen cases involved the left knee and 19 the right knee. The mean BMI was 22.19\u0026thinsp;\u0026plusmn;\u0026thinsp;2.71 kg/m\u0026sup2;. In terms of trauma history, 12 patients had a history of trauma while 21 did not. The mean symptom duration was 6.46\u0026thinsp;\u0026plusmn;\u0026thinsp;3.54 weeks. Outerbridge grading was as follows: Grade 0 in 9 cases, Grade 1 in 18 cases, and Grade 2 in 6 cases.\u003c/p\u003e\u003cp\u003eNo statistically significant differences were observed in the baseline characteristics between the two groups. Details are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e The study was approved by the institutional ethics committee of The First Affiliated Hospital of Huzhou University, [Ethics (Review) No. 2024KYLL015-02]. Informed consent was waived because of the retrospective design. All experiments were conducted in accordance with the guidelines and regulations of the Helsinki Declaration.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of general data of tpatients with posterior root injury of the medial meniscus between two groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal (N)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003cp\u003e(years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSex Male/Female\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eInvolved Side\u003c/p\u003e\u003cp\u003eL/R\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePrevious Trauma (Yes/No)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eDuration of Symptoms (weeks)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eOuterbridge Grade \u003c/p\u003e\u003cp\u003e(0/1/2)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePalliative Suturing Group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e53.92\u0026thinsp;\u0026plusmn;\u0026thinsp;2.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11/14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12/14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e22.07\u0026thinsp;\u0026plusmn;\u0026thinsp;2.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7/19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e7.38\u0026thinsp;\u0026plusmn;\u0026thinsp;3.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e6/15/5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePull-Out Repair Group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e54.79\u0026thinsp;\u0026plusmn;\u0026thinsp;2.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15/18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14/19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e22.21\u0026thinsp;\u0026plusmn;\u0026thinsp;3.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e12/21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e7.24\u0026thinsp;\u0026plusmn;\u0026thinsp;2.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e9/18/6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eStatistical Values\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;1.517\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eχ\u0026sup2;=0.058\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ\u0026sup2;=0.082\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;0.186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eχ\u0026sup2;=0.594\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003et=-0.186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eχ\u0026sup2;=1.364\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ep\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.135\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.809\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.775\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.853\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.441\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.853\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.506\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e1.3 Treatment Methods\u003c/h2\u003e\u003cdiv id=\"Sec7\" class=\"Section3\"\u003e\u003ch2\u003e1.3.1 Preoperative Preparation\u003c/h2\u003e\u003cp\u003eAfter admission, patients underwent routine blood tests, coagulation studies, preoperative infectious disease screening, weight-bearing anteroposterior and lateral knee radiographs at 45\u0026deg; flexion, MRI of the affected knee, and full-length weight-bearing radiographs of both lower limbs. Surgery was scheduled after exclusion of any surgical contraindications.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section3\"\u003e\u003ch2\u003e1.3.2 Surgical Technique\u003c/h2\u003e\u003cp\u003eAll surgical procedures were performed by two senior sports medicine physicians from the same surgical team.\u003c/p\u003e\u003cp\u003eStandard anteromedial and anterolateral portals were established. The anterolateral portal served as the viewing portal for a comprehensive arthroscopic examination of the knee to rule out possible occult injuries in other structures. When visualization of the medial meniscus posterior root was difficult due to a tight medial compartment, the \"pie-crusting\" technique was applied percutaneously using a 12-gauge needle to release the medial collateral ligament, thereby improving exposure of the medial compartment.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\n\u003ch3\u003ePalliative Suturing Group\u003c/h3\u003e\n\u003cp\u003eThe anterolateral portal was used as the viewing portal and the anteromedial portal as the working portal. Before repair, the tissue structures at the meniscal root attachment site were carefully identified arthroscopically. A meniscal rasp or shaver was then used to debride and freshen the free end of the torn posterior root.\u003c/p\u003e\u003cp\u003eAfter preparing the stump, a meniscal suture device was introduced through the working portal. A stitch was placed on the superior surface of the root stump, 2\u0026ndash;3 mm medial to the free edge, performing a vertical mattress suture to secure the posterior root to the fibers of the posterior cruciate ligament (PCL). If the posterior root remained unstable after the first suture, a second suture was placed parallel to the first.\u003c/p\u003e\u003cp\u003eAfter suturing, the stability of the repair was assessed by viewing again through the anteromedial portal while an assistant flexed the knee beyond 90\u0026deg;. A representative case is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003ePull-Out Repair Group\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe anterolateral portal was used as the viewing portal and the anteromedial portal as the working portal. A shaver was then employed to thoroughly debride the residual tissue at the meniscal posterior root attachment site and to freshen the free edge of the degenerated meniscal tissue.\u003c/p\u003e\u003cp\u003eWe utilized an anterior cruciate ligament (ACL) tibial tunnel guide as a targeting device, set at an angle of 45\u0026deg;. The dense tissue attachment point of the posterior root served as the intra-articular exit of the bone tunnel, and the anteromedial cortex of the proximal tibia served as the extra-articular exit. A 2.5 mm diameter guide pin was inserted into the tibia, followed by the creation of a 4.5 mm diameter tibial bone tunnel along the guide pin.\u003c/p\u003e\u003cp\u003eA #0 high-strength suture (Smith \u0026amp; Nephew) was passed through the free end tissue of the medial meniscus posterior root using a suture passing instrument #2 PDS suture, fixed in a looped configuration. The high-strength suture was then passed through the prepared tibial bone tunnel to the extra-articular side using the pre-placed shuttle suture. Under continuous arthroscopic visualization, with the knee flexed at 90\u0026deg;, the suture was tensioned and secured to the anteromedial tibial cortex using a button plate. After the repair was completed, the stability of the sutured site was assessed again by viewing through the anteromedial portal while an assistant flexed the knee beyond 90\u0026deg;. A representative case is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec10\" class=\"Section3\"\u003e\u003cdiv class=\"Heading\"\u003e1.3.3 Rehabilitation Protocol\u003c/div\u003e\u003cp\u003eMuscle strength training, including quadriceps contractions, straight leg raises, and ankle pump exercises, was initiated immediately after surgery. For the first 3 weeks postoperatively, the affected limb was immobilized in full extension using a brace, and weight-bearing was prohibited.\u003c/p\u003e\u003cp\u003eFrom week 4, knee flexion and extension exercises were started within a 0\u0026deg;\u0026ndash;30\u0026deg; range. Between weeks 5 and 10, the range of motion was progressively increased by approximately 15\u0026deg; per week until 120\u0026deg; was achieved. Partial weight-bearing was gradually introduced beginning at week 8, with full weight-bearing permitted 3 months postoperatively. Return to sports activities was allowed no earlier than 6 months after surgery.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section3\"\u003e\u003cdiv class=\"Heading\"\u003e1.4.1 Clinical Functional Assessment\u003c/div\u003e\u003cp\u003eThe same author, who was not involved in the surgical procedures, assessed knee function using the Lysholm score and the International Knee Documentation Committee (IKDC) subjective knee evaluation form. Assessments were conducted preoperatively and at the 2-year postoperative follow-up.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section3\"\u003e\u003cdiv class=\"Heading\"\u003e1.4.2 Imaging Evaluation\u003c/div\u003e\u003cp\u003e\u003cstrong\u003eRadiographs\u003c/strong\u003e\u003cp\u003eWeight-bearing anteroposterior (AP) radiographs of the affected knee at 45\u0026deg; flexion, lateral radiographs, and full-length weight-bearing radiographs of both lower limbs were obtained. The Kellgren-Lawrence (K-L) grading system \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e was used to assess the severity of osteoarthritis. The full-length weight-bearing radiographs were utilized to evaluate lower limb alignment.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMagnetic Resonance Imaging (MRI)\u003c/strong\u003e\u003cp\u003eMRI was used to diagnose medial meniscus posterior root tears, assess the progression of meniscal extrusion, and evaluate the healing status of the repaired root. The \"truncated triangle sign\" on coronal images and the \"ghost meniscus sign\" on sagittal images were considered characteristic MRI findings for diagnosing MMPRT. Focal cartilage lesions in the medial femoral condyle and medial tibial plateau were graded on preoperative and postoperative MRI scans according to the International Cartilage Repair Society (ICRS) classification system \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003c/p\u003e\u003cp\u003eMeniscal extrusion distance was specifically defined as the distance, measured on coronal images at the midpoint of the medial femoral condyle from initial and final MRI scans, between the outer edge of the medial tibial plateau and the outer edge of the medial meniscus along a vertical line \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. Postoperative healing of the posterior root was classified into three grades based on MRI appearance: complete healing (continuity observed in all three planes: sagittal, coronal, and axial), partial healing (loss of continuity in any one or two planes), and non-union/re-tear (loss of continuity in all planes) \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eAll patients underwent the corresponding radiographic and MRI examinations both preoperatively and at the final follow-up.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e1.5 Statistical Analysis\u003c/h2\u003e\u003cp\u003eStatistical analysis was performed using SPSS software (SPSS 24.0, IBM Inc., Chicago, Illinois, United States). A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003cp\u003eCategorical data, such as gender, affected side, trauma history, intergroup comparisons of meniscal extrusion, and intragroup comparisons before and after treatment, were analyzed using the chi-square test. Intergroup comparisons of preoperative Outerbridge grade, Kellgren-Lawrence (K-L) grade, MRI cartilage injury grade, and meniscal healing degree, as well as their intragroup comparisons before and after treatment, were analyzed using Fisher's exact test.\u003c/p\u003e\u003cp\u003eFor continuous quantitative data, such as age, BMI, symptom duration, follow-up time, meniscal extrusion distance, Lysholm score, and IKDC score, normality was first assessed. Data conforming to a normal distribution are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (X̄ \u0026plusmn; S) and were compared between groups using the independent samples t-test. Data not conforming to a normal distribution are presented as median (25th percentile, 75th percentile) (Md (P25, P75)) and were compared between groups using the Mann-Whitney U test (rank-sum test). Intragroup comparisons of continuous data before and after surgery were performed using the paired samples t-test for normally distributed data and the Wilcoxon signed-rank test (paired samples rank-sum test) for non-normally distributed data.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Functional Outcomes\u003c/h2\u003e\u003cp\u003eNo statistically significant differences were observed in the total or individual domain scores of the IKDC between the two groups either preoperatively or at the 2-year postoperative follow-up (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Similarly, comparison of the total Lysholm scores between the two groups preoperatively and at 2 years postoperatively showed no statistically significant differences (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). There were also no statistically significant differences in the individual item scores of the Lysholm scale (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Details are presented in Tables\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of IKDC scores of patients with posterior root injury of the medial meniscus between two groups before operation and 2 years after operation\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"10\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eClinical Symptoms\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003eAthletic Activities\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003eFunction\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003eTotal Score\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePreoperative\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2-Year Postoperative Follow-up\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePreoperative\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2-Year Postoperative Follow-up\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePreoperative\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2-Year Postoperative Follow-up\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003ePreoperative\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2-Year Postoperative Follow-up\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePalliative Suturing Group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e26\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.61\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27.88\u0026thinsp;\u0026plusmn;\u0026thinsp;1.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12.19\u0026thinsp;\u0026plusmn;\u0026thinsp;2.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e35.27\u0026thinsp;\u0026plusmn;\u0026thinsp;2.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.85\u0026thinsp;\u0026plusmn;\u0026thinsp;1.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e7.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e38.31\u0026thinsp;\u0026plusmn;\u0026thinsp;3.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e70.58\u0026thinsp;\u0026plusmn;\u0026thinsp;2.70\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePull-Out Repair Group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e33\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.50\u0026thinsp;\u0026plusmn;\u0026thinsp;1.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28.35\u0026thinsp;\u0026plusmn;\u0026thinsp;1.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12.67\u0026thinsp;\u0026plusmn;\u0026thinsp;1.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e35.43\u0026thinsp;\u0026plusmn;\u0026thinsp;2.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.21\u0026thinsp;\u0026plusmn;\u0026thinsp;1.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e7.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e39.48\u0026thinsp;\u0026plusmn;\u0026thinsp;2.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e71.03\u0026thinsp;\u0026plusmn;\u0026thinsp;2.03\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTest Value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;0.329\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et=-1.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;0.987\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;0.987\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;1.269\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;0.961\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;1.342\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;0.735\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eP\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.095\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.285\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.918\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.051\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.069\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.135\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of Lysholm scores of patients with posterior root injury of the medial meniscus between two groups before operation and 2 years after operation\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eLimp\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003eSupport\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003eLocking\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePreoperative\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2-Year Postoperative Follow-up\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePreoperative\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2-Year Postoperative Follow-up\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePreoperative\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2-Year Postoperative Follow-up\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePalliative Suturing Group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e26\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.92\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.15\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.08\u0026thinsp;\u0026plusmn;\u0026thinsp;1.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e5.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6.92\u0026thinsp;\u0026plusmn;\u0026thinsp;2.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e14.23\u0026thinsp;\u0026plusmn;\u0026thinsp;1.84\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePull-Out Repair Group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e33\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.09\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.79\u0026thinsp;\u0026plusmn;\u0026thinsp;0.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.82\u0026thinsp;\u0026plusmn;\u0026thinsp;1.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e5.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6.73\u0026thinsp;\u0026plusmn;\u0026thinsp;1.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e14.39\u0026thinsp;\u0026plusmn;\u0026thinsp;1.66\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTest Value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;0.631\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et=-1.397\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003et=-0.678\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003et=-0.358\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;0.358\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eP\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.918\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.667\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.177\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.134\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.478\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eInstability\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003ePain\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003eSwelling\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePreoperative\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2-Year Postoperative Follow-up\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePreoperative\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2-Year Postoperative Follow-up\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePreoperative\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2-Year Postoperative Follow-up\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePalliative Suturing Group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e26\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10(10,10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20(20,20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7.88\u0026thinsp;\u0026plusmn;\u0026thinsp;2.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e13.65\u0026thinsp;\u0026plusmn;\u0026thinsp;4.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6(6,6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e6(6,6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePull-Out Repair Group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e33\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10(10,10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20(20,20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7.27\u0026thinsp;\u0026plusmn;\u0026thinsp;2.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e12.58\u0026thinsp;\u0026plusmn;\u0026thinsp;2.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6(6,6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e6(6,6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTest Value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eZ=-1.265\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eZ=-0.554\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003et=-0.924\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003et=-1.233\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eZ=-0.513\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eZ=-1.678\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eP\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.206\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.580\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.637\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.093\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.093\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eStair Climbing\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003eSquatting\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003eLysholm score\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePreoperative\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2-Year Postoperative Follow-up\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePreoperative\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2-Year Postoperative Follow-up\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePreoperative\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2-Year Postoperative Follow-up\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePalliative Suturing Group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e26\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6(2,6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6(6,6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4(4,4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.5(4,5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e45.23\u0026thinsp;\u0026plusmn;\u0026thinsp;4.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e73.96\u0026thinsp;\u0026plusmn;\u0026thinsp;4.73\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePull-Out Repair Group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e33\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6(6,6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6(6,6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4(4,4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4(4,4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e45.55\u0026thinsp;\u0026plusmn;\u0026thinsp;4.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e73.21\u0026thinsp;\u0026plusmn;\u0026thinsp;2.99\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTest Value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eZ=-0.702\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eZ=-0.170\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eZ=-0.411\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eZ=-1.043\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;0.278\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003et=-0.742\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eP\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.483\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.865\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.681\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.297\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.782\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.461\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Imaging Outcomes\u003c/h2\u003e\u003cp\u003eA statistically significant difference was observed in the preoperative Kellgren-Lawrence grade, cartilage injury grade, presence of meniscal extrusion, and extent of extrusion when compared within each group before and after surgery (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, no statistically significant differences were found between the two groups at the 2-year postoperative follow-up regarding Kellgren-Lawrence grade, cartilage injury grade, presence of meniscal extrusion, or meniscal healing status (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003eNotably, a statistically significant difference was detected in the extent of postoperative meniscal extrusion between the groups (Palliative Suturing vs. Pull-Out Repair: 3.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74 mm vs. 3.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81 mm; p\u0026thinsp;=\u0026thinsp;0.041).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of imaging indexes of patients with posterior root injury of the medial meniscus between two groups before operation and 2 years after operation\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"19\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c16\" colnum=\"16\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c17\" colnum=\"17\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c18\" colnum=\"18\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c19\" colnum=\"19\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e\u003cp\u003eKellgren-Lawrence Grade\u003c/p\u003e\u003cp\u003e (0/1/2)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c10\" namest=\"c7\"\u003e\u003cp\u003eCartilage Injury Grade\u003c/p\u003e\u003cp\u003e(0/1/2)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c14\" namest=\"c11\"\u003e\u003cp\u003eMeniscal Extrusion\u003c/p\u003e\u003cp\u003e(Yes/No)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c18\" namest=\"c15\"\u003e\u003cp\u003eExtent of Meniscal Extrusion(mm)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c19\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eMeniscal Healing\u003c/p\u003e\u003cp\u003e(Complete/Partial/Non-union)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePreoperative\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2-Year Postoperative Follow-up\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTest Value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePreoperative\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2-Year Postoperative Follow-up\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eTest Value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003ePreoperative\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e\u003cp\u003e2-Year Postoperative Follow-up\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c13\"\u003e\u003cp\u003eTest Value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c14\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c15\"\u003e\u003cp\u003ePreoperative\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c16\"\u003e\u003cp\u003e2-Year Postoperative Follow-up\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c17\"\u003e\u003cp\u003eTest Value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c18\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePalliative Suturing Group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e26\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13/11/2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10/13/3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003eχ\u0026sup2;=0.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.698\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e12/10/4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e6/15/5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003eχ\u0026sup2;=3.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e13/13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e20/6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003eχ\u0026sup2;=4.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e\u003cp\u003e0.041\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e3.177\u0026thinsp;\u0026plusmn;\u0026thinsp;0.763\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e3.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003et=-0.830\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c18\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c19\"\u003e\u003cp\u003e14/10/2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePull-Out Repair Group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e33\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18/10/5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14/14/5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003eχ\u0026sup2;=1.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.456\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e13/15/5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e12/14/7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003eχ\u0026sup2;=0.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.756\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e17/16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e19/14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003eχ\u0026sup2;=055\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e\u003cp\u003e0.458\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e3.167\u0026thinsp;\u0026plusmn;\u0026thinsp;1.045\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e3.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003et=-1.115\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c18\"\u003e\u003cp\u003e0.038\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c19\"\u003e\u003cp\u003e17/15/1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTest Value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eχ\u0026sup2;=1.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eχ\u0026sup2;=0.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eχ\u0026sup2;=0.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eχ\u0026sup2;=2.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eχ\u0026sup2;=0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eχ\u0026sup2;=3.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003et=-0.042\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003et=-2.086\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c19\"\u003e\u003cp\u003eχ\u0026sup2;=1.20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eP\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.458\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.811\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.831\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.354\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.888\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.083\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e0.967\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e0.041\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c19\"\u003e\u003cp\u003e0.549\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Complications\u003c/h2\u003e\u003cp\u003eIn the pull-out repair group, one patient developed postoperative incisional redness, swelling, and discharge. The infection was successfully resolved after intravenous administration of cefuroxime and regular wound dressing changes. No other patients in either group required revision surgery or underwent knee arthroplasty during the follow-up period.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Advantages and Limitations of Traditional MMPRT Repair Techniques\u003c/h2\u003e\u003cp\u003eAn MMPRT alters the mechanical environment of the medial compartment of the knee, accelerating the progression of knee osteoarthritis. Therefore, root repair surgery is generally recommended once the diagnosis is confirmed \u003csup\u003e[\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Traditional root repair techniques include the pull-out repair and the all-inside side-to-side suturing technique. Although studies have confirmed the therapeutic efficacy of these repair procedures, each technique has certain limitations, which may prevent some patients with MMPRT from receiving optimal treatment \u003csup\u003e[\u003cspan additionalcitationids=\"CR7 CR8 CR9\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe pull-out repair is a classic technique for posterior root restoration, capable of anatomically reconstructing the torn meniscal root tissue and restoring the normal anatomical configuration of the meniscus. However, this method presents the following limitations in clinical practice: (1) It requires specific instruments to establish the tibial tunnel, resulting in longer operative time and greater tissue trauma; (2) In patients with concomitant osteoporosis, there is a risk of postoperative failure due to suture cut-through and subsequent loosening; (3) Histological studies suggest that after tibial tunnel healing, issues such as incomplete histological integration and reduced biomechanical strength at the meniscus-bone interface may occur \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eCompared to the pull-out transosseous repair technique, the all-inside side-to-side suture technique offers advantages such as being less invasive, technically less demanding, and eliminating the need for tibial tunnel drilling. Studies have confirmed that its biomechanical strength is comparable to that of the pull-out reconstruction \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. Furthermore, clinical research suggests that anatomic all-inside side-to-side suturing can achieve superior clinical outcomes compared to pull-out reconstruction \u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e, making it one of the promising future directions in MMPRT treatment.\u003c/p\u003e\u003cp\u003eHowever, in practical application, we have observed that this method still presents the following limitations: (1) It is only applicable to Laprade type I and II injuries \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e; (2) It requires sufficient residual meniscal tissue on the tibial side for adequate suture anchor fixation. To preserve the benefits of the all-inside technique while expanding its indications and clinical applications, researchers have proposed a repair technique that involves suturing the meniscal posterior root to the fibers of the posterior cruciate ligament \u003csup\u003e[\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003e\u003cb\u003e3.2 Differences in Functional Outcomes, Imaging Findings, and Meniscal Extrusion Between Palliative All-Inside Suturing and Pull-Out Repair for MMPRT\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(1) Functional Outcomes\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eThe recovery of knee function is the most intuitive indicator for evaluating treatment efficacy. Our study found no statistically significant difference in the improvement of knee function between palliative all-inside suturing and pull-out repair. Whether through all-inside palliative suturing or pull-out repair, most patient symptoms can be significantly alleviated once the posterior root structure is stably fixed. However, patients should be informed preoperatively that symptoms caused by pre-existing joint degeneration cannot be improved by root repair alone.\u003c/p\u003e\u003cp\u003e\u003cb\u003e(2) Imaging Findings\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eNo significant progression of knee degeneration was observed at 2 years postoperatively in either the palliative all-inside suturing group or the pull-out repair group. This suggests that the palliative suturing technique can partially restore the mechanical environment of the medial compartment, thereby delaying the progression of knee osteoarthritis. The overall healing rate (complete\u0026thinsp;+\u0026thinsp;partial healing) of the posterior root was 92.31% (24/26) in the palliative all-inside suturing group and 95.97% (32/36) in the pull-out repair group, which is generally consistent with previous studies \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. Although numerically slightly lower in the palliative group, statistical analysis confirmed no significant difference. Thus, posterior root healing after palliative suturing does not appear to be a particular concern.\u003c/p\u003e\u003cp\u003e\u003cb\u003e(3) Meniscal Extrusion\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eMeniscal extrusion increases both the mean and peak contact pressures in the tibiofemoral joint and is one of the predictors of osteoarthritis progression. In our study, neither palliative suturing nor pull-out repair halted meniscal extrusion, and the degree of extrusion was more severe in the palliative suturing group (3.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74 mm vs. 3.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81 mm; p\u0026thinsp;=\u0026thinsp;0.041). The lack of significant difference in postoperative Kellgren-Lawrence grading between groups may be attributed to multiple factors. First, the absolute difference in the increase of postoperative extrusion was relatively small (0.57 mm in the palliative group vs. 0.15 mm in the pull-out group), potentially resulting in minimal changes in local stress. Second, this study represents a mid-term follow-up of 2 years, which may be insufficient for the mechanical changes to manifest as significant cartilage wear or osteoarthritis progression. Confirming differences between the techniques may require incorporating more osteoarthritis-related imaging parameters and longer follow-up periods. While the short-term efficacy of meniscal centralization has been demonstrated \u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e, its long-term impact on osteoarthritis remains to be further investigated. We also plan to explore the application of palliative suturing combined with meniscal centralization in future studies.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003e3.3 Research Background and Technical Characteristics of the Palliative Suturing Technique\u003c/h2\u003e\u003cp\u003eAnatomical studies have shown that the center of the medial meniscus posterior root is located 8.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7 mm from the superior edge of the tibial insertion of the posterior cruciate ligament (PCL) in cadaveric specimens \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. Therefore, suturing the posterior root to the PCL has been proposed as an alternative when side-to-side repair is not feasible for MMPRT. Biomechanical studies have confirmed that this repair method can restore tibiofemoral contact area, contact pressure, and peak pressure to levels comparable to those of an intact knee. Sun et al. \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e reported in their retrospective study that suturing the meniscal posterior root to the PCL fibers improved clinical function, radiological outcomes, cartilage degeneration, and meniscal extrusion progression. Jiang \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e also confirmed the clinical efficacy of the palliative suturing technique.\u003c/p\u003e\u003cp\u003eIn addition to sharing the general advantages of all-inside techniques, palliative suturing is specifically suitable for cases where the residual meniscal tissue on the tibial side is insufficient for side-to-side all-inside repair. However, since this technique does not anatomically reconstruct the meniscal hoop structure, it may not fully restore the biomechanical environment of the medial compartment. Therefore, its long-term impact on the progression of osteoarthritis remains unclear. Based on this limitation, the authors do not recommend palliative suturing as a routine choice for MMPRT repair.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe palliative all-inside suturing technique yields similar outcomes to pull-out repair in terms of functional improvement and radiological results for patients with MMPRT, making it a valuable supplementary option for posterior root repair. However, given that this technique does not achieve anatomical reconstruction of the medial meniscus posterior root, it is not recommended as a routine treatment for MMPRT.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u003c/strong\u003e All authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThe authors received no funding for this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors and Affiliations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXu Youyue\u003csup\u003e1,2\u003c/sup\u003e, Shen Zheyuan\u003csup\u003e1,2\u003c/sup\u003e, Zhu Xinhong (corresponding author)\u003csup\u003e1,2\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e1.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe First Affiliated Hospital of Huzhou University \u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003eThe First People\u0026apos;s Hospital of Huzhou, Department of Orthopedics, Huzhou 313000，Zhejiang, China; 2. Huzhou Key Laboratory for Early Diagnosis and Treatment of Osteoarthritis, Huzhou 313000，Zhejiang, China\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e Xu Youyue was responsible for patient follow-up, data registration, and manuscript writing; Shen Zheyuan was responsible for study design, statistical analysis, and data verification; Zhu Xinhong was responsible for manuscript review.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorresponding author:\u0026nbsp;\u003c/strong\u003eZhu Xinhong, E-mail: [email protected]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the institutional ethics committee of The First Affiliated Hospital of Huzhou University, [Ethics (Review) No. 2024KYLL015-02]. All experiments were conducted in accordance with the guidelines and regulations of the Helsinki Declaration. Every human participant in the study declares their informed consent to participate in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePublication of clinical datasets\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ewe are bound by the strict data privacy policies of our institution, The First Affiliated Hospital of Huzhou University, and ethical regulations governing patient confidentiality.\u0026nbsp;We can provide further clarification on the data collection and processing methods upon request to ensure the study is thoroughly understood.\u0026nbsp;Please contact the corresponding author at\u0026nbsp;[email protected].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eObtain informed consent from all participants in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLaPrade CM, James EW, Cram TR, Feagin JA, Engebretsen L, LaPrade RF. Meniscal root tears: a classification system based on tear morphology. Am J Sports Med. 2015;43(2):363\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLaPrade CM, Foad A, Smith SD, et al. Biomechanical consequences of a nonanatomic posterior medial meniscal root repair. Am J Sports Med. 2015;43(4):912\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKrivicich LM, Kunze KN, Parvaresh KC, et al. Comparison of Long-term Radiographic Outcomes and Rate and Time for Conversion to Total Knee Arthroplasty Between Repair and Meniscectomy for Medial Meniscus Posterior Root Tears: A Systematic Review and Meta-analysis. Am J Sports Med. 2022;50(7):2023\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKim SB, Ha JK, Lee SW, et al. Medial meniscus root tear refixation: comparison of clinical, radiologic, and arthroscopic findings with medial meniscectomy. Arthroscopy. 2011;27(3):346\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKrych AJ, Lamba A, Wang AS, et al. Nonoperative Management of Degenerative Medial Meniscus Posterior Root Tears: Poor Outcomes at a Minimum 10-Year Follow-up. Am J Sports Med. 2023;51(10):2603\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKim YM, Rhee KJ, Lee JK, Hwang DS, Yang JY, Kim SJ. Arthroscopic pullout repair of a complete radial tear of the tibial attachment site of the medial meniscus posterior horn. Arthroscopy. 2006;22(7):e7951\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKrych AJ, Nauert RF 3rd, Song BM, et al. Association Between Transtibial Meniscus Root Repair and Rate of Meniscal Healing and Extrusion on Postoperative Magnetic Resonance Imaging: A Prospective Multicenter Study. Orthop J Sports Med. 2021;9(8):23259671211023774.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePasic N, Storaci H, Guzman R, et al. A Biomechanical Comparison of All-Inside Versus Transtibial Meniscus Root Repair Techniques. Am J Sports Med. 2023;51(9):2366\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYoon KH, Lee W, Park JY. Outcomes of Arthroscopic All-Inside Repair Are Improved Compared to Transtibial Pull-Out Repair of Medial Meniscus Posterior Root Tears. Arthroscopy. 2023;39(5):1254\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDzidzishvili L, L\u0026oacute;pez-Torres II, S\u0026aacute;ez D, Arguello JM, Calvo E. A comparison of the transtibial pullout technique and all-inside meniscal repair in medial meniscus posterior root tear: Prognostic factors and midterm clinical outcomes. J Orthop. 2021;26:130\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJiang J, Xing D, Ni L, Chen J. Non-Anatomical Arthroscopic All-Inside Repair of Medial Meniscus Posterior Root Tear to Posterior Cruciate Ligament for Patients with Normal Lower Limb Alignment. Orthop Surg. 2022;14(2):397\u0026ndash;404.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSu J, Wan H, Pang Y, et al. Trans-Posterior Cruciate Ligament All-Inside Root Repair Versus Partial Meniscectomy for Medial Meniscus Posterior Root Tears: Comparison of Semiquantitative and Quantitative MRI Outcomes in Cartilage Degeneration and Osteoarthritic Progression. Cartilage. 2022;13(3):19476035221114242.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSu J, Wan H, Pang Y, et al. Clinical, Radiographic, and MRI Evaluation of All-Inside Medial Meniscus Posterior Root Repair via Suture Fixation to the Posterior Cruciate Ligament Versus Partial Meniscectomy: Results at 3-Year Follow-up. Orthop J Sports Med. 2023;11(7):23259671231180545.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChoi SH, Bae S, Ji SK, Chang MJ. The MRI findings of meniscal root tear of the medial meniscus: emphasis on coronal, sagittal and axial images. Knee Surg Sports Traumatol Arthrosc. 2012;20(10):2098\u0026ndash;103.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKrych AJ, Johnson NR, Mohan R, et al. Arthritis Progression on Serial MRIs Following Diagnosis of Medial Meniscal Posterior Horn Root Tear. J Knee Surg. 2018;31(7):698\u0026ndash;704.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKELLGREN JH, LAWRENCE JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16(4):494\u0026ndash;502.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrittberg M, Winalski CS. Evaluation of cartilage injuries and repair. J Bone Joint Surg Am 2003 85-A Suppl 2: 58\u0026ndash;69.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChoi CJ, Choi YJ, Lee JJ, Choi CH. Magnetic resonance imaging evidence of meniscal extrusion in medial meniscus posterior root tear. Arthroscopy. 2010;26(12):1602\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDeng XH, Wang JS, Chen Z et al. Incomplete Histologic Healing and Diminished Biomechanical Strength of Meniscus-Bone Interface After Medial Meniscus Posterior Root Transosseous Repair in a Goat Model. Arthroscopy. 2024: S0749-8063(24)00552-8 [pii].\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVertullo CJ, Cadman J, Dabirrahmani D, Appleyard R. Biomechanical Comparison of an All-Inside Meniscal Repair Device Construct Versus Pullout Sutures for Arthroscopic Transtibial Repair of Posterior Medial Meniscus Root Tears: A Matched-Pair Cadaveric Study. Orthop J Sports Med. 2021;9(4):23259671211000464.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYoon KH, Lee W, Park JY. Reprint of: Outcomes of Arthroscopic All-Inside Repair Are Improved Compared to Transtibial Pull-Out Repair of Medial Meniscus Posterior Root Tears. Arthroscopy. 2023;39(6):1376\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJohannsen AM, Civitarese DM, Padalecki JR, Goldsmith MT, Wijdicks CA, LaPrade RF. Qualitative and quantitative anatomic analysis of the posterior root attachments of the medial and lateral menisci. Am J Sports Med. 2012;40(10):2342\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChung KS, Ha JK, Ra HJ, Kim JG. A meta-analysis of clinical and radiographic outcomes of posterior horn medial meniscus root repairs. Knee Surg Sports Traumatol Arthrosc. 2016;24(5):1455\u0026ndash;68.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChung KS, Ha JK, Ra HJ, Nam GW, Kim JG. Pullout Fixation of Posterior Medial Meniscus Root Tears: Correlation Between Meniscus Extrusion and Midterm Clinical Results. Am J Sports Med. 2017;45(1):42\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChernchujit B, Prasetia R. Arthroscopic direct meniscal extrusion reduction: surgical tips to reduce persistent meniscal extrusion in meniscal root repair. Eur J Orthop Surg Traumatol. 2018;28(4):727\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"medial meniscus posterior root tear, meniscal repair, all-inside repair Pull-out reconstruction","lastPublishedDoi":"10.21203/rs.3.rs-7894659/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7894659/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eTo investigate the clinical efficacy of palliative suture technique that suture the posterior root to the posterior cruciate ligament and pull-out reconstruction technique in the treatment of medial meniscus posterior root tear (MMPRT).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA total of 59 patients with MMPRT who received surgical treatment in our hospital From September 2022 to July 2024 were included in this study, and were divided into the palliative suture group and the Pull-out reconstruction group according to different treatment technique. In the palliative suture group, there were 26cases, 9 males and 17 females, aged 54.49±2.57 years, disease course 7.75±4.75 weeks; In the Pull-out reconstruction group，there were 33 cases, 15 males and 18 females, age of 55.29±2.23 years, disease course 6.46±3.54 weeks. Clinical outcomes were assessed using International Knee Documentation Committee Subjective Knee Form (IKDC) and Lysholm functional questionnaire. The progression of arthritis, meniscus extraction and meniscus healing were evaluated through X-ray and MRI examinations of the knee joint.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThere was no statistically significant difference in the IKDC score and Lysholm score two years after surgery between two groups (palliative suture group vs pull-out reconstruction group: IKDC score 70.58±2.70 vs 71.03±2.03 p=0.135; Lysholm score: 73.96±4.73 vs 73.21±2.99 p=0.461), And there is no statistical difference in the comparison of each sub-item. There was no statistically significant difference in the incidence two years after surgery between the two groups (palliative suture group vs Pull-out reconstruction group: 76.92% vs 57.58% \u0026nbsp;p=0.083) ; while there was statistically significant difference in the degree of extraction (palliative suture group vs pull-out reconstruction group: 3.75±0.74mm vs 3.33±0.81mm p=0.041). There was no statistically significant difference in the meniscus healing results between the two groups after surgery (palliative suture group vs Pull-out reconstruction group: Complete healing was achieved in 14 cases 53.85%), partial healing in 10 cases 38.46%), and non-healing in 2 cases (7.69%) vs complete healing in 17 cases (51.52%), partial healing in 15 cases (45.45%), and non-healing in 1 case (3.03%), p=0.549).\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe palliative all-inside suture technique is similar to Pull-out reconstruction in improving knee joint function and imaging outcomes in patients with MMPRT. It is a good supplement to the MMPRT repair techniques. However, considering that the palliative suture method is not an anatomical reconstruction of the posterior root of the medial meniscus, it is not recommended to use this technique as a routine technique for MMPRT repair.\u003c/p\u003e","manuscriptTitle":"Comparison of the therapeutic effects of palliative all-inside suture technique and pull-out reconstruction technique in the treatment of medial meniscus posterior root tear","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-14 07:09:08","doi":"10.21203/rs.3.rs-7894659/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-11-29T08:24:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-28T04:42:40+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-26T12:14:51+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-26T11:52:26+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-23T16:53:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"238340288604339333301556400090303389992","date":"2025-11-23T14:01:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"35467241424029657024382265386660966906","date":"2025-11-19T08:20:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"95512435288104453430660845441325604273","date":"2025-11-17T15:53:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"303615357033166097221533394582656070855","date":"2025-11-16T10:41:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"214138240355434379108133901565031701842","date":"2025-11-15T15:19:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"112685138994095959900162438220372747022","date":"2025-11-04T00:49:38+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-04T00:47:28+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-04T00:45:44+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-03T06:05:31+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-02T16:19:25+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Musculoskeletal Disorders","date":"2025-11-02T15:12:37+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c6b142e2-5647-4ff4-be16-e64701264532","owner":[],"postedDate":"November 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-11-14T07:09:08+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-14 07:09:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7894659","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7894659","identity":"rs-7894659","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}