Arthroscopic Medial Meniscus Posterior Root Repair and Centralization With Medial Capsulodesis Using a Knotless Soft Anchor

Meniscal extrusion after posterior root tears of the medial meniscus disrupts the knee hoop-stress mechanism and increases joint contact pressure, accelerating osteoarthritis. Even with an anatomic root repair, extrusion often persists. Meniscal centralization has been proposed as a complementary strategy to restore joint biomechanics and reduce stress on the repaired root. This technique combines transtibial pull-out repair of the medial meniscus posterior root with meniscal centralization and medial capsulodesis. A tibial tunnel is created for root fixation using a FiberWire suture, and centralization is performed using an outside-in technique with 2 spinal needles and a single 1.8-mm knotless anchor. This allows simultaneous stabilization of the medial capsule and the meniscotibial ligament. This approach offers improved anchoring of the medial meniscus for effective centralization through reinforcement of capsule and meniscotibial ligament with reduced need for expensive or bulky instruments. The use of spinal needles lowers the risk of iatrogenic cartilage injury. This combined method is simple, efficient, and cost-effective. It enhances biomechanical stability, minimizes extrusion, and reduces surgical complexity potentially leading to better outcomes in treating posterior medial meniscal root tears.