All meniscal root repairs were performed arthroscopically using a transtibial style of repair. After a diagnostic arthroscopy was performed and any other concomitant pathology was addressed (ACL or medial collateral ligament repair), the anatomic attachment site of the medial meniscal root was identified ( Fig 2 ). In all cases, fenestration of the superficial medial collateral ligament was performed to increase the medial compartment’s working space. The medial meniscus’s anatomic posterior root attachment site was identified, and a curette or shaver was used to create a bleeding bony surface. Next, an arthroscopic meniscal passing device was used to pass 2 to 3 luggage-tag No. 2 nonabsorbable sutures into the posterior portion of the medial meniscal root. A meniscal root or ACL tibial guide was then used to pass a 2.4-mm cannulated guide pin, starting from the anteromedial tibia and exiting at the center of the anatomic meniscal root. The inner pin was removed to allow for the use of a passing stitch to shuttle the previously passed luggage-tag No. 2 nonabsorbable sutures through the tibial tunnel. The knee was then cycled, and the sutures were fixed using either a titanium button or a suture anchor with the knee at 30° of flexion. The process was repeated to suture and drill the tunnel for the lateral meniscal root. It should be noted that the starting point for the medial root tunnel was created on the medial aspect of the medial tibia to avoid convergence. The lateral meniscal root repair’s starting point on the tibia was slightly more lateral and near the tibial crest.

Representative magnetic resonance imaging with arrows indicating root tear locations (A) and arthroscopic imaging showing medial (A) and lateral (B) meniscal root tears in one patient.

These procedures were performed by 7 different board-certified, sports medicine–trained orthopaedic surgeons from the same clinic in Colorado. Postoperatively, all patients were placed into a hinged knee brace locked in extension for 6 weeks. Patients were restricted to 0° to 90° of range of motion for 6 weeks, with avoidance of hamstring strengthening for 12 weeks, and were made non–weight-bearing for 6 weeks. Clinical follow-ups occurred at 2 weeks, 6 weeks, 12 weeks, and 6 months routinely, with yearly remote questionnaire follow-up thereafter.

PROs were obtained preoperatively and postoperatively with a minimum follow-up time of 2 years. Preoperative PROs were acquired through an online survey given to all patients at the preoperative appointment, and postoperative PROs were collected through an online questionnaire that was emailed to participants. Patients without 2-year PROs were contacted by the research team 3 times before being considered lost to follow-up. Collected PROs included the International Knee Documentation Committee subjective knee evaluation (IKDC), Lysholm score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short Form 12 (SF-12) Physical Component Summary (SF-12 PCS), Short Form 12 Mental Component Summary (SF-12 MCS), and Tegner Activity Scale. These PROs were selected because they are widely used for understanding recovery in patients undergoing knee surgery. ^, The IKDC is an 18-item questionnaire scored from 0 to 100 that evaluates knee symptoms, function, and sports activity, on which higher scores mean better function. The Lysholm score is an 8-item questionnaire evaluating knee function with questions about pain, instability, locking, squatting, and so on, ranging from 0 to 100, with higher scores reflecting better knee function, and the Tegner Activity Scale consists of a single item scoring a patient’s highest level of activity from 0 to 10. The WOMAC includes 24 items assessing pain, stiffness, and physical function in patients with knee osteoarthritis, scored from 0 to 96, with higher scores being better. The SF-12 is a 12-item composite score of physical health (SF-12 PCS) and mental well-being (SF-12 MCS), ranging from 0 to 100, with higher scores being better. The minimal clinically important difference was reported for the Lysholm score, IKDC score, SF-12 PCS score, and WOMAC Total using previously validated cutoff values. The patient acceptable symptom state was reported for the Lysholm and IKDC scores. ^,, Satisfaction was assessed at final follow-up on a scale of 0 to 10, with 0 of 10 being highly unsatisfied and 10 of 10 being completely satisfied. All subsequent ipsilateral knee surgical procedures were reviewed for circumstance.

PROs were reported as medians, minima, and maxima. The Wilcoxon signed rank test was used to test for statistically significant improvement from baseline to a minimum of 2 years postoperatively. The Mann-Whitney U test and Fisher exact test were used to compare continuous and categorical variables, respectively, between the dual-repair and non–dual-repair groups. P <.05 was deemed statistically significant. Given the fixed sample size of 6 dual-repair patients and 7 non–dual-repair patients with known minimum 2-year PRO scores, assuming a Mann-Whitney U test with an α level of.05, 80% statistical power was achieved to detect an effect size (Cohen d ) of 1.76. In general, a Cohen d of 0.2 is considered a small effect; 0.5, a moderate affect; and 0.8, a large effect. Thus, our study had a very large effect size. Subtler between-group effects cannot be ruled out by this study. All statistical analyses were performed using the statistical computing language R, version 4.4.0 (R Core Team, Vienna, Austria), with additional package gtsummary. ^,