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Background/Objectives: While arthroscopic repair is established for the treatment of medial meniscus posterior root tears (MMPRT), the relationship between physiotherapy (PT) exposure, meniscal extrusion (ME), and structural healing remains unclear. The aim of this study was to evaluate short-term functional and structural results after transtibial pull-out (TPO) repair of isolated MMPRT and to explore the influence of patient age and postoperative physiotherapy volume. Methods: A retrospective single-center case series with 14 adults (64% women, age 59 years, body mass index (BMI) 31.0 kg/m²) who underwent TPO repair (April 2022–June 2024). Mean follow-up was 18.4 months. Outcomes included range of motion (ROM), pain levels using visual analog scale (VAS), International Knee Documentation Committee (IKDC), the Western Ontario Meniscal Evaluation Tool (WOMET), the 36-Item Short Form Survey (SF-36), and MRI-based ME, cartilage grade, and root-healing status. Postoperative PT volume was assessed with a self-developed, custom questionnaire. Correlations and subgroup analyses (<60 vs. ≥60 years) were performed. Results: Mean postoperative ROM was 121° and IKDC 63.4. Median PT exposure was 25.9 h, and the mean duration from symptom to repair was 215 days. MRI demonstrated complete healing in 70% of cases. A positive correlation was observed between postoperative ME and ROM (p = 0.008), while higher PT volume was associated with greater pain scores. Conclusions: TPO repair appears to be a viable treatment option for selected patients with MMPRT, showing acceptable early outcomes, even in older individuals with higher BMIs or delayed repair. Meniscal healing was frequent, although extrusion progression remained common and may influence the function. The observed links between ME, ROM, and PT-related pain highlight the need for standardized rehabilitation assessment. Larger, prospective studies are warranted to validate these exploratory findings and refine postoperative management. Full article

Background: Despite advances in repair techniques, the failure rates of meniscal surgery are still high. The seven most common tear types—horizontal cleavage tears (HCTs), radial tears (RTs), meniscal ramp lesions (MRLs), meniscal root tears (MRTs), longitudinal tears (LTs), bucket-handle tears (BHMTs), and complex meniscal tears (CMTs)—were reviewed. The present retrospective observational study aimed to analyze their characteristics, incidence, treatment approach and failure rates of a consecutive cohort of patients undergoing meniscal arthroscopic repair. Methods: The database of a high-volume meniscal suture center was examined for lesions managed by all-inside, inside-out, outside-in, or transtibial pull-out techniques from January 2018 to September 2022. Demographic (gender, age at surgery, laterality of the affected knee) and intraoperative data (tear type/site, repair technique, and suture number/combination) were collected in order to calculate the failure rates of the cohort and of each tear type and suture technique. Results: Altogether, 636 procedures met our criteria of having at least a 2-year follow-up. The overall failure rate was 1.98%. The most frequent lesions were HCTs (41.98%), with most injuries being in the body/posterior horn (88.52%) of the right knee (56.92%). Treatment predominantly (92.50%) included all-inside sutures. All-inside repair had the highest failure rate (2.98%), followed by inside-out (1.56%) repair (p = 1.0), whereas outside-in and pull-out techniques never failed. Failure rates by lesion included BHMTs (7.27%), HCTs (2.25%), CMTs (1.49%), and LTs (1.25%); RMT, RML, and MRT repair were always successful. Conclusions: Findings at two years suggest that 1–3 all-inside sutures minimize MRL failure, whereas three or more all-inside sutures or combined techniques seem to be effective for HCTs, LTs, and RTs but not BHMTs. Pull-out repair worked best for complete tears/avulsion types of MRTs, whereas all-inside sutures effectively managed partial lesions. Results for CMTs were inconclusive. Full article