Editorial Commentary: Transtibial Centralization Is Biomechanically Better Than Knotless Anchor Centralization When Repairing a Medial Meniscal Posterior Root Tear-But Only Just.

Medial meniscal posterior root tears are associated with medial meniscal extrusion, a decrease in tibiofemoral contact area, an increase in contact pressures, an acceleration of cartilage degeneration, and a high rate of progression to total knee arthroplasty. Although a medial meniscal posterior root repair may help slow the degenerative process, meniscal extrusion can persist after a repair. Strategies to reduce residual meniscal extrusion include ensuring that the repair is anatomical, using suture tape to minimize suture cut-out, performing an adequate capsular release, and restricting weight-bearing for 4 to 6 weeks postoperatively. The addition of a centralization suture also may help reduce meniscal extrusion by anchoring the meniscal body to the rim of the tibial plateau prior to root fixation. This can be achieved by inserting a further transtibial suture or suture anchors, with the transtibial tunnel or suture anchors located just central to the rim at the apex of the posteromedial aspect of the medial tibial plateau.