The menisci play a fundamental role in maintaining normal knee biomechanics by distributing load, absorbing shock, providing stability, and facilitating joint lubrication. Damage to the meniscus, particularly root tears, disrupts hoop tension and leads to altered joint loading patterns. This condition accelerates cartilage degeneration and predisposes patients to early-onset osteoarthritis, especially when untreated or inadequately managed.

Posterior root medial meniscus tears (PRMMTs) have gained increasing clinical attention in the past two decades. These injuries are biomechanically equivalent to a total meniscectomy because they cause extrusion of the meniscus and loss of its load- sharing capacity. PRMMTs typically affect middle-aged and older patients, often associated with degenerative changes, but can also occur in younger populations following trauma or high-impact activities.

The clinical presentation of PRMMTs is often subtle, with patients experiencing posterior knee pain, mechanical symptoms, and joint line tenderness. Magnetic resonance imaging (MRI) remains the gold standard for diagnosis, with characteristic findings such as the "ghost sign" and meniscal extrusion beyond 3 mm. However, diagnosis is frequently delayed, contributing to the progression of cartilage degeneration by the time of surgical intervention.

Several risk factors have been identified, including female gender, obesity, varus malalignment, and increased posterior tibial slope. These factors not only predispose patients to PRMMTs but also influence the prognosis following surgical repair. Given the high prevalence of these risk factors, especially in populations with rising obesity and osteoarthritis incidence, effective treatment strategies have become essential.

Surgical repair techniques have evolved significantly to restore hoop stresses and improve long-term outcomes. Two widely practiced arthroscopic methods are the transtibial pullout suture repair and the suture anchor repair. Both aim to reattach the meniscal root to its anatomical footprint, thereby restoring biomechanics and delaying degenerative progression.

Inclusion Criteria:

• Age between 20 and 50 years, both sexes.
• Acute or degenerative posterior root tear of the medial meniscus confirmed by MRI.
• Isolated medial meniscus root tear or tear associated with anterior cruciate ligament (ACL) injury.
• Willingness to participate and sign informed consent.

Exclusion Criteria:

• Refusal to participate.
• Knee joint malalignment (varus/valgus) confirmed clinically and radiologically.
• Osteoarthritis grade III or IV according to Kellgren-Lawrence classification.
• Irreparable or severely degenerated crushed meniscus.
• Prior ipsilateral knee fracture, infection, or tumor.
• Patients were deemed unfit for surgery or anesthesia.