Transtibial Pull Out Method Versus Suture Anchor Method for Meniscus Extrusion

Official title

Comparison of Transtibial Pull Out Method And Suture Anchor Method in Surgical Treatment of Meniscus Extrusion

Overview

The concept of meniscal extrusion has recently been recognized as an important pathological condition associated with meniscal dysfunction. Meniscal extrusion is the medial or lateral displacement of the meniscus beyond the edges of the tibial plateau. Some meniscal extrusions are physiologic, but large degrees of extrusion are thought to be pathologic. Meniscal extrusion can vary in extent from minimal physiological extrusion to extrusions exceeding 10 mm. The generally accepted threshold value is considered to be 3 mm. To date, the gold standard for measuring meniscal extrusion is T2-weighted MRI. MRI is valuable not only due to its ability to define other meniscal or knee pathologies but also because it provides good sensitivity and specificity. Surgical treatment of meniscal extrusion is preferred in young, active, symptomatic patients and individuals with acute injuries. The treatment approach may vary depending on the underlying cause. One of these methods is centralization surgery, which aims to achieve the anatomical reduction of the extruded meniscus. The aim of this study is to compare the functional outcomes of transtibial pull-out and suture anchor techniques used in centralization surgery and to contribute to standardization.

Interventions

• Procedure Transtibial Pull Out Method
  The Transtibial Pull-Out Repair is a surgical technique used to fix posterior root tears of the meniscus, particularly in the medial meniscus. This method restores the hoop stress mechanism of the meniscus, which is essential for knee stability and function.
• Procedure Suture Anchor Method
  The Suture Anchor Technique is an alternative to the Transtibial Pull-Out Method for repairing posterior meniscal root tears, especially in the medial meniscus. Instead of using a tibial tunnel, this technique fixes the meniscal root directly to the native footprint using suture anchors.

Primary outcome measures

• Change in the amount of meniscus extrusion in MR images. [Time frame: From enrollment to the end of treatment at 12 months]

Secondary outcome measures (3)

• Lysholm score [Time frame: From enrollment to the end of treatment at 3, 6 and 12 months.]
• Tegner activity score [Time frame: From enrollment to the end of treatment at 3, 6 and 12 months.]
• International Knee Documentation Committee (IKDC) Score [Time frame: From enrollment to the end of treatment at 3, 6 and 12 months.]

Eligibility criteria

Inclusion criteria

• Presence of meniscal extrusion greater than 3 mm on MRI scans
• Symptomatic complaints in the knee with extrusion

Exclusion criteria

• Malalignment greater than 5 degrees
• Presence of Kellgren-Lawrence grade 3-4 osteoarthritis

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Treatment

Study locations

Turkey (Türkiye) · 1 center

• Ataturk University Hospital — Erzurum

Publications

• Yan X, Sahu S, Li H, Zhou W, Xiong T, Chen S, Li C, Hao L. Arthroscopic meniscal posterior root repair combined with centralization reduces medial meniscus extrusion associated with posterior root tears: One-year clinical outcomes. Knee Surg Sports Traumatol Arthrosc. 2025 Aug;33(8):2825-2832. doi: 10.1002/ksa.12533. Epub 2024 Nov 14. PMID 39543774
• Zhou Y, Yang Q, Kang J, Xu J, Chen M, Wu C. Clinical effect of medial meniscus posterior root repair combined with centralization technique in the treatment of medial meniscus posterior root tears. BMC Musculoskelet Disord. 2024 Nov 30;25(1):982. doi: 10.1186/s12891-024-08125-2. PMID 39616323

Identifiers

NCT: NCT06906783 · ATAUNIORTHO

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗