All-inside repair is an effective treatment for medial meniscus posterior root tears: a systematic review and meta-analysis of biomechanical and clinical evidence

T Cerasoli; V G Rinaldi; A Fogacci; M P Neri; G M Marcheggiani Muccioli; S Zaffagnini; A Grassi

doi:10.1016/j.knee.2026.104501

All-inside repair is an effective treatment for medial meniscus posterior root tears: a systematic review and meta-analysis of biomechanical and clinical evidence

Knee. 2026 Jun 2:62:104501. doi: 10.1016/j.knee.2026.104501. Online ahead of print.

Authors

T Cerasoli¹, V G Rinaldi², A Fogacci¹, M P Neri³, G M Marcheggiani Muccioli⁴, S Zaffagnini⁴, A Grassi⁴

Affiliations

¹ Department of Biomedical and Neuromotor Sciences DIBINEM, Alma Mater Studiorum University of Bologna, Bologna, Italy.
² 2nd Orthopedic and Traumatologic Clinic, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy. Electronic address: vitogaetano.rinaldi@ior.it.
³ 2nd Orthopedic and Traumatologic Clinic, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy.
⁴ Department of Biomedical and Neuromotor Sciences DIBINEM, Alma Mater Studiorum University of Bologna, Bologna, Italy; 2nd Orthopedic and Traumatologic Clinic, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy.

PMID: 42228997
DOI: 10.1016/j.knee.2026.104501

Abstract

Background: Medial meniscus posterior root tears (MMPRTs) reproduce the biomechanics of subtotal meniscectomy. Repair is favored, but the role of all-inside repair (AR) remains unclear relative to transtibial pull-out (TP). This study aimed to review the biomechanical and clinical evidence on AR for MMPRTs.

Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in the International Prospective Register of Systematic Reviews (PROSPERO). MEDLINE, Embase, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched. Outcomes included patient-reported outcome measures (PROMs), magnetic resonance imaging (MRI), and biomechanical performance. When available, random-effects meta-analysis was performed.

Results: Thirteen studies were included. AR restored contact mechanics and showed load to failure comparable to TP, with lower stiffness. Meta-analysis showed lower conversion to total knee arthroplasty with AR versus non-repair (RR 0.18, 95% CI 0.05-0.58), and no significant PROM differences between AR and TP.

Conclusions: AR showed favorable biomechanical properties and improved outcomes versus non-repair. Compared with TP, no significant clinical differences were observed. AR may represent a reasonable option in selected scenarios.

Keywords: All-inside; All-inside repair; MMPRT; Medial meniscal root tear; Root tear.

Publication types

Review