OTSR - 2026-08-08 - Journal Article; Review
Absorbable Versus Non-Absorbable Suture Materials in Transtibial Pull-Out Repair of Medial Meniscus Posterior Root Tears: A Systematic Review and Meta-Analysis.
Han JH, Kim SH, Jung M, Choi CH, Chung K, Jung SH, Kim TH, Moon HS
Topics
Key Takeaway
Suture material (absorbable vs. non-absorbable) showed no statistically significant effect on any clinical or radiological outcome after transtibial pull-out repair for medial meniscus posterior root tears across 647 patients, though TKA conversion trended higher with absorbable sutures (22% vs. 5%).
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Summary
This PRISMA-compliant systematic review and meta-analysis asked whether suture absorbability influences outcomes after transtibial pull-out repair for medial meniscus posterior root tears. Sixteen studies (1 Level II, 7 Level III, 8 Level IV) were pooled; subgroup analyses by suture type found no significant differences in IKDC (P=0.07), Lysholm (P=0.43), meniscal extrusion (P=0.19), MRI healing (P=0.77), KL grade progression (P=0.75), or TKA conversion (P=0.06). Pooled MRI healing was 60% for non-absorbable and 68% for absorbable sutures; pooled TKA conversion was 5% vs. 22%, respectively, though neither reached statistical significance.
Key Limitation
All comparisons are indirect across heterogeneous observational studies with no within-study randomization, making it impossible to isolate suture absorbability as an independent variable from confounders such as concomitant procedures, fixation technique variation, and postoperative rehabilitation protocols.
Original Abstract
BACKGROUND
Transtibial pull-out repair is widely used for the treatment of medial meniscus posterior root tears (MMRTs). However, the optimal suture material remains unclear despite differences in biomechanical and biological properties between absorbable and non-absorbable sutures. This study aimed to evaluate whether suture material influences clinical and radiological outcomes after transtibial pull-out repair for MMRTs through a systematic review and meta-analysis.
METHODS
This systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. Eligible studies reporting clinical or radiological outcomes after transtibial pull-out repair for MMRTs were included. Extracted data included patient-reported outcomes, magnetic resonance imaging (MRI)-based meniscal healing, meniscal extrusion, Kellgren-Lawrence (KL) grade progression, and conversion to total knee arthroplasty (TKA). Random-effects meta-analyses and subgroup analyses were performed according to suture absorbability, and meta-regression was used to explore potential sources of heterogeneity.
RESULTS
Sixteen studies encompassing 647 patients were included; these comprised one Level II study, seven Level III studies, and eight Level IV studies. No significant subgroup differences according to suture absorbability were identified for changes in International Knee Documentation Committee score (P = 0.07), Lysholm score (P = 0.43), meniscal extrusion (P = 0.19), MRI-based meniscal healing (P = 0.77), KL grade progression (P = 0.75), or conversion to TKA (P = 0.06). The pooled healing proportions were 0.60 (95% CI, 0.33-0.82) for non-absorbable sutures and 0.68 (95% CI, 0.00-1.00) for absorbable sutures. The corresponding pooled proportions of conversion to TKA were 0.05 (95% CI, 0.00-1.00) and 0.22 (95% CI, 0.10-0.38), respectively.
CONCLUSION
The available evidence did not identify statistically significant differences in clinical or radiological outcomes between absorbable and non-absorbable sutures after transtibial pull-out repair for MMRTs. However, because these findings were derived primarily from indirect comparisons across heterogeneous studies, they should not be interpreted as evidence of equivalence, and the current evidence remains insufficient to determine whether suture absorbability independently influences postoperative outcomes.
LEVEL OF EVIDENCE
IV; systematic review and meta-analysis of Level II-IV studies.