Research progress of meniscal centralization for degenerative medial meniscus extrusion_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHAO Qian , NIU Xingyue ,  HUANG Jingmin

Department of Sports Medicine and Arthroscopy Surgery, Tianjin Hospital, Tianjin, 300211, P. R. China;

Corresponding?author：

HUANG Jingmin, Email: huangjingmin@126.com

Keywords：

Meniscus extrusion; centralization surgery technique; degenerative joint disease of the knee; knee arthroscopy

DOI：

10.7507/1002-1892.202508068

Video：

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Objective To review the biomechanical rationale, surgical techniques, and clinical outcomes of meniscal centralization for degenerative medial meniscus extrusion. Methods A comprehensive literature search was conducted on recent domestic and international studies focusing on biomechanics, surgical methods, and clinical applications of meniscal centralization. Results Meniscus extrusion (radial displacement ≥3 mm beyond the tibial plateau) is commonly associated with degenerative knee conditions, leading to meniscal dysfunction and accelerated osteoarthritis progression. Meniscal centralization is a surgical technique that reduces extrusion by suturing the displaced meniscus back to the tibial plateau, thereby restoring its coverage and load-sharing function. Biomechanical studies have demonstrated its efficacy in reducing extrusion and improving joint contact mechanics. Surgical techniques primarily include the Pull-out method and anchor-based fixation, often supplemented by Pie-crusting release and meniscal mobilization to facilitate reduction. Clinical evidence suggests that centralization, either alone or combined with high tibial osteotomy and/or meniscal root repair, can improve short-term functional scores, reduce extrusion, and potentially delay joint degeneration. Conclusion Meniscal centralization represents a promising joint-preserving technique with favorable biomechanical and early clinical outcomes. However, its long-term efficacy warrants further investigation through high-quality studies.

1.	Faucett SC, Geisler BP, Chahla J, et al. Meniscus root repair vs meniscectomy or nonoperative management to prevent knee osteoarthritis after medial meniscus root tears: Clinical and economic effectiveness. Am J Sports Med, 2019, 47(3): 762-769.
2.	?uczkiewicz P, Daszkiewicz K, Chró?cielewski J, et al. High meniscal slope angle as a risk factor for meniscal allograft extrusion. Med Hypotheses, 2017, 101: 48-51.
3.	Krych AJ, Bernard CD, Leland DP, et al. Isolated meniscus extrusion associated with meniscotibial ligament abnormality. Knee Surg Sports Traumatol Arthrosc, 2020, 28(11): 3599-3605.
4.	Swamy N, Wadhwa V, Bajaj G, et al. Medial meniscal extrusion: Detection, evaluation and clinical implications. Eur J Radiol, 2018, 102: 115-124.
5.	Kaiser JT, Damodar D, Udine MJ, et al. Meniscal extrusion: A critical analysis review. JBJS Rev, 2022, 10(7). doi: 10.2106/JBJS.RVW.22.00019.
6.	Koga H, Muneta T, Yagishita K, et al. Arthroscopic centralization of an extruded lateral meniscus. Arthrosc Tech, 2012, 1(2): e209-e212.
7.	Koga H, Nakamura T, Nakagawa Y, et al. Arthroscopic centralization using knotless anchors for extruded medial meniscus. Arthrosc Tech, 2021, 10(3): e639-e645.
8.	Koga H, Muneta T, Watanabe T, et al. Two-year outcomes after arthroscopic lateral meniscus centralization. Arthroscopy, 2016, 32(10): 2000-2008.
9.	Koga H, Watanabe T, Horie M, et al. Augmentation of the pullout repair of a medial meniscus posterior root tear by arthroscopic centralization. Arthrosc Tech, 2017, 6(4): e1335-e1339.
10.	Ozeki N, Muneta T, Kawabata K, et al. Centralization of extruded medial meniscus delays cartilage degeneration in rats. J Orthop Sci, 2017, 22(3): 542-548.
11.	Amano Y, Ozeki N, Matsuda J, et al. Augmentation of a nonanatomical repair of a medial meniscus posterior root tear with centralization using three knotless anchors may be associated with less meniscal extrusion and better compressive load distribution in mid-flexion compared with non-anatomical root repair alone in a porcine knee model. Arthroscopy, 2023, 39(12): 2487-2498.
12.	Daney BT, Aman ZS, Krob JJ, et al. Utilization of transtibial centralization suture best minimizes extrusion and restores tibiofemoral contact mechanics for anatomic medial meniscal root repairs in a cadaveric model. Am J Sports Med, 2019, 47(7): 1591-1600.
13.	Claret G, Monta?ana J, Rios J, et al. The effect of percutaneous release of the medial collateral ligament in arthroscopic medial meniscectomy on functional outcome. Knee, 2016, 23(2): 251-255.
14.	Jeon SW, Jung M, Chun YM, et al. The percutaneous pie-crusting medial release during arthroscopic procedures of the medial meniscus does neither affect valgus laxity nor clinical outcome. Knee Surg Sports Traumatol Arthrosc, 2018, 26(10): 2912-2919.
15.	Kotipalli S, Blackman B, Vivekanantha P, et al. Pie-crusting the medial collateral ligament is a safe and effective technique for improving visualisation and access in arthroscopic meniscal surgery: A systematic review. Knee Surg Sports Traumatol Arthrosc, 2025. doi: 10.1002/ksa.70103.
16.	Moran TE, Awowale JT, Werner BC, et al. Associated morbidity after the percutaneous release of the medial collateral ligament for knee arthroscopy. Arthroscopy, 2020, 36(3): 891-900.
17.	LaPrade CM, Foad A, Smith SD, et al. Biomechanical consequences of a nonanatomic posterior medial meniscal root repair. Am J Sports Med, 2015, 43(4): 912-920.
18.	DePhillipo NN, Kennedy MI, Chahla J, et al. Type Ⅱ medial meniscus root repair with peripheral release for addressing meniscal extrusion. Arthrosc Tech, 2019, 8(9): e941-e946.
19.	Chernchujit B, Prasetia R. Arthroscopic direct meniscal extrusion reduction: surgical tips to reduce persistent meniscal extrusion in meniscal root repair. Eur J Orthop Surg Traumatol, 2018, 28(4): 727-734.
20.	Nakamura R, Takahashi M, Kuroda K, et al. Suture anchor repair for a medial meniscus posterior root tear combined with arthroscopic meniscal centralization and open wedge high tibial osteotomy. Arthrosc Tech, 2018, 7(7): e755-e761.
21.	Leafblad ND, Smith PA, Stuart MJ, et al. Arthroscopic centralization of the extruded medial meniscus. Arthrosc Tech, 2020, 10(1): e43-e48.
22.	Radaelli S, Farinelli L, Minoli C, et al. Arthroscopic medial meniscus posterior root repair and centralization with medial capsulodesis using a knotless soft anchor. Arthrosc Tech, 2025, 14(9): 103787. doi: 10.1016/j.eats.2025.103787.
23.	Wu TY. Arthroscopic medial meniscus posterior root repair with centralization using knotless suture anchors. Arthrosc Tech, 2022, 11(4): e661-e668.
24.	Munugoda IP, Beavers DP, Wirth W, et al. The effect of weight loss on the progression of meniscal extrusion and size in knee osteoarthritis: a post-hoc analysis of the Intensive Diet and Exercise for Arthritis (IDEA) trial. Osteoarthritis Cartilage, 2020, 28(4): 410-417.
25.	Sharma K, Eckstein F, Wirth W, et al. Meniscus position and size in knees with versus without structural knee osteoarthritis progression: data from the osteoarthritis initiative. Skeletal Radiol, 2022, 51(5): 997-1006.
26.	Roemer FW, Kwoh CK, Hannon MJ, et al. Risk factors for magnetic resonance imaging-detected patellofemoral and tibiofemoral cartilage loss during a six-month period: the joints on glucosamine study. Arthritis Rheum, 2012, 64(6): 1888-1898.
27.	Katagiri H, Nakagawa Y, Miyatake K, et al. Short-term outcomes after high tibial osteotomy aimed at neutral alignment combined with arthroscopic centralization of medial meniscus in osteoarthritis patients. J Knee Surg, 2023, 36(3): 261-268.
28.	Tokumoto Y, Nakagawa Y, Nakamura T, et al. Combined medial meniscus repair, centralization, and high tibial osteotomy are associated with improved clinical, radiological, and arthroscopic outcomes in patients with posterior root tears and varus alignment. Arthroscopy, 2025, 16: S0749-S8063.
29.	Yoon KH, Bae BS, Ahn JH, et al. More than 3 mm of preoperative medial meniscal extrusion is identified as a key risk factor for varus progression in limb alignment after arthroscopic repair of medial meniscus posterior root tear. Knee Surg Sports Traumatol Arthrosc, 2024, 32(9): 2239-2247.
30.	Kodama Y, Furumatsu T, Masuda S, et al. Transtibial fixation for medial meniscus posterior root tear reduces posterior extrusion and physiological translation of the medial meniscus in middle-aged and elderly patients. Knee Surg Sports Traumatol Arthrosc, 2020, 28(11): 3416-3425.
31.	Shah I, S Majeed I, Kurian NP. Medial meniscus root tears: Management with single-tunnel repair and meniscus centralization. Cureus, 2025, 17(5): e84425. doi: 10.7759/cureus.84425.
32.	LaPrade RF, LaPrade CM, James EW. Recent advances in posterior meniscal root repair techniques. J Am Acad Orthop Surg, 2015, 23(2): 71-76.
33.	Chung KS, Ha JK, Ra HJ, et al. A meta-analysis of clinical and radiographic outcomes of posterior horn medial meniscus root repairs. Knee Surg Sports Traumatol Arthrosc, 2016, 24(5): 1455-1468.
34.	Feucht MJ, Kühle J, Bode G, et al. Arthroscopic transtibial pullout repair for posterior medial meniscus root tears: A systematic review of clinical, radiographic, and second-look arthroscopic results. Arthroscopy, 2015, 31(9): 1808-1816.
35.	Moon HK, Koh YG, Kim YC, et al. Prognostic factors of arthroscopic pull-out repair for a posterior root tear of the medial meniscus. Am J Sports Med, 2012, 40(5): 1138-1143.
36.	Kim SB, Ha JK, Lee SW, et al. Medial meniscus root tear refixation: comparison of clinical, radiologic, and arthroscopic findings with medial meniscectomy. Arthroscopy, 2011, 27(3): 346-354.
37.	Mochizuki Y, Kawahara K, Samejima Y, et al. Short-term results and surgical technique of arthroscopic centralization as an augmentation for medial meniscus extrusion caused by medial meniscus posterior root tear. Eur J Orthop Surg Traumatol, 2021, 31(6): 1235-1241.
38.	Krych AJ, Boos AM, Lamba A, et al. Satisfactory clinical outcome, complications, and provisional results of meniscus centralization with medial meniscus root repair for the extruded medial meniscus at mean 2-year follow-up. Arthroscopy, 2024, 40(5): 1578-1587.
39.	Yan X, Sahu S, Li H, et al. Arthroscopic meniscal posterior root repair combined with centralization reduces medial meniscus extrusion associated with posterior root tears: One-year clinical outcomes. Knee Surg Sports Traumatol Arthrosc, 2025, 33(8): 2825-2832.

1. Faucett SC, Geisler BP, Chahla J, et al. Meniscus root repair vs meniscectomy or nonoperative management to prevent knee osteoarthritis after medial meniscus root tears: Clinical and economic effectiveness. Am J Sports Med, 2019, 47(3): 762-769.
2. ?uczkiewicz P, Daszkiewicz K, Chró?cielewski J, et al. High meniscal slope angle as a risk factor for meniscal allograft extrusion. Med Hypotheses, 2017, 101: 48-51.
3. Krych AJ, Bernard CD, Leland DP, et al. Isolated meniscus extrusion associated with meniscotibial ligament abnormality. Knee Surg Sports Traumatol Arthrosc, 2020, 28(11): 3599-3605.
4. Swamy N, Wadhwa V, Bajaj G, et al. Medial meniscal extrusion: Detection, evaluation and clinical implications. Eur J Radiol, 2018, 102: 115-124.
5. Kaiser JT, Damodar D, Udine MJ, et al. Meniscal extrusion: A critical analysis review. JBJS Rev, 2022, 10(7). doi: 10.2106/JBJS.RVW.22.00019.
6. Koga H, Muneta T, Yagishita K, et al. Arthroscopic centralization of an extruded lateral meniscus. Arthrosc Tech, 2012, 1(2): e209-e212.
7. Koga H, Nakamura T, Nakagawa Y, et al. Arthroscopic centralization using knotless anchors for extruded medial meniscus. Arthrosc Tech, 2021, 10(3): e639-e645.
8. Koga H, Muneta T, Watanabe T, et al. Two-year outcomes after arthroscopic lateral meniscus centralization. Arthroscopy, 2016, 32(10): 2000-2008.
9. Koga H, Watanabe T, Horie M, et al. Augmentation of the pullout repair of a medial meniscus posterior root tear by arthroscopic centralization. Arthrosc Tech, 2017, 6(4): e1335-e1339.
10. Ozeki N, Muneta T, Kawabata K, et al. Centralization of extruded medial meniscus delays cartilage degeneration in rats. J Orthop Sci, 2017, 22(3): 542-548.
11. Amano Y, Ozeki N, Matsuda J, et al. Augmentation of a nonanatomical repair of a medial meniscus posterior root tear with centralization using three knotless anchors may be associated with less meniscal extrusion and better compressive load distribution in mid-flexion compared with non-anatomical root repair alone in a porcine knee model. Arthroscopy, 2023, 39(12): 2487-2498.
12. Daney BT, Aman ZS, Krob JJ, et al. Utilization of transtibial centralization suture best minimizes extrusion and restores tibiofemoral contact mechanics for anatomic medial meniscal root repairs in a cadaveric model. Am J Sports Med, 2019, 47(7): 1591-1600.
13. Claret G, Monta?ana J, Rios J, et al. The effect of percutaneous release of the medial collateral ligament in arthroscopic medial meniscectomy on functional outcome. Knee, 2016, 23(2): 251-255.
14. Jeon SW, Jung M, Chun YM, et al. The percutaneous pie-crusting medial release during arthroscopic procedures of the medial meniscus does neither affect valgus laxity nor clinical outcome. Knee Surg Sports Traumatol Arthrosc, 2018, 26(10): 2912-2919.
15. Kotipalli S, Blackman B, Vivekanantha P, et al. Pie-crusting the medial collateral ligament is a safe and effective technique for improving visualisation and access in arthroscopic meniscal surgery: A systematic review. Knee Surg Sports Traumatol Arthrosc, 2025. doi: 10.1002/ksa.70103.
16. Moran TE, Awowale JT, Werner BC, et al. Associated morbidity after the percutaneous release of the medial collateral ligament for knee arthroscopy. Arthroscopy, 2020, 36(3): 891-900.
17. LaPrade CM, Foad A, Smith SD, et al. Biomechanical consequences of a nonanatomic posterior medial meniscal root repair. Am J Sports Med, 2015, 43(4): 912-920.
18. DePhillipo NN, Kennedy MI, Chahla J, et al. Type Ⅱ medial meniscus root repair with peripheral release for addressing meniscal extrusion. Arthrosc Tech, 2019, 8(9): e941-e946.
19. Chernchujit B, Prasetia R. Arthroscopic direct meniscal extrusion reduction: surgical tips to reduce persistent meniscal extrusion in meniscal root repair. Eur J Orthop Surg Traumatol, 2018, 28(4): 727-734.
20. Nakamura R, Takahashi M, Kuroda K, et al. Suture anchor repair for a medial meniscus posterior root tear combined with arthroscopic meniscal centralization and open wedge high tibial osteotomy. Arthrosc Tech, 2018, 7(7): e755-e761.
21. Leafblad ND, Smith PA, Stuart MJ, et al. Arthroscopic centralization of the extruded medial meniscus. Arthrosc Tech, 2020, 10(1): e43-e48.
22. Radaelli S, Farinelli L, Minoli C, et al. Arthroscopic medial meniscus posterior root repair and centralization with medial capsulodesis using a knotless soft anchor. Arthrosc Tech, 2025, 14(9): 103787. doi: 10.1016/j.eats.2025.103787.
23. Wu TY. Arthroscopic medial meniscus posterior root repair with centralization using knotless suture anchors. Arthrosc Tech, 2022, 11(4): e661-e668.
24. Munugoda IP, Beavers DP, Wirth W, et al. The effect of weight loss on the progression of meniscal extrusion and size in knee osteoarthritis: a post-hoc analysis of the Intensive Diet and Exercise for Arthritis (IDEA) trial. Osteoarthritis Cartilage, 2020, 28(4): 410-417.
25. Sharma K, Eckstein F, Wirth W, et al. Meniscus position and size in knees with versus without structural knee osteoarthritis progression: data from the osteoarthritis initiative. Skeletal Radiol, 2022, 51(5): 997-1006.
26. Roemer FW, Kwoh CK, Hannon MJ, et al. Risk factors for magnetic resonance imaging-detected patellofemoral and tibiofemoral cartilage loss during a six-month period: the joints on glucosamine study. Arthritis Rheum, 2012, 64(6): 1888-1898.
27. Katagiri H, Nakagawa Y, Miyatake K, et al. Short-term outcomes after high tibial osteotomy aimed at neutral alignment combined with arthroscopic centralization of medial meniscus in osteoarthritis patients. J Knee Surg, 2023, 36(3): 261-268.
28. Tokumoto Y, Nakagawa Y, Nakamura T, et al. Combined medial meniscus repair, centralization, and high tibial osteotomy are associated with improved clinical, radiological, and arthroscopic outcomes in patients with posterior root tears and varus alignment. Arthroscopy, 2025, 16: S0749-S8063.
29. Yoon KH, Bae BS, Ahn JH, et al. More than 3 mm of preoperative medial meniscal extrusion is identified as a key risk factor for varus progression in limb alignment after arthroscopic repair of medial meniscus posterior root tear. Knee Surg Sports Traumatol Arthrosc, 2024, 32(9): 2239-2247.
30. Kodama Y, Furumatsu T, Masuda S, et al. Transtibial fixation for medial meniscus posterior root tear reduces posterior extrusion and physiological translation of the medial meniscus in middle-aged and elderly patients. Knee Surg Sports Traumatol Arthrosc, 2020, 28(11): 3416-3425.
31. Shah I, S Majeed I, Kurian NP. Medial meniscus root tears: Management with single-tunnel repair and meniscus centralization. Cureus, 2025, 17(5): e84425. doi: 10.7759/cureus.84425.
32. LaPrade RF, LaPrade CM, James EW. Recent advances in posterior meniscal root repair techniques. J Am Acad Orthop Surg, 2015, 23(2): 71-76.
33. Chung KS, Ha JK, Ra HJ, et al. A meta-analysis of clinical and radiographic outcomes of posterior horn medial meniscus root repairs. Knee Surg Sports Traumatol Arthrosc, 2016, 24(5): 1455-1468.
34. Feucht MJ, Kühle J, Bode G, et al. Arthroscopic transtibial pullout repair for posterior medial meniscus root tears: A systematic review of clinical, radiographic, and second-look arthroscopic results. Arthroscopy, 2015, 31(9): 1808-1816.
35. Moon HK, Koh YG, Kim YC, et al. Prognostic factors of arthroscopic pull-out repair for a posterior root tear of the medial meniscus. Am J Sports Med, 2012, 40(5): 1138-1143.
36. Kim SB, Ha JK, Lee SW, et al. Medial meniscus root tear refixation: comparison of clinical, radiologic, and arthroscopic findings with medial meniscectomy. Arthroscopy, 2011, 27(3): 346-354.
37. Mochizuki Y, Kawahara K, Samejima Y, et al. Short-term results and surgical technique of arthroscopic centralization as an augmentation for medial meniscus extrusion caused by medial meniscus posterior root tear. Eur J Orthop Surg Traumatol, 2021, 31(6): 1235-1241.
38. Krych AJ, Boos AM, Lamba A, et al. Satisfactory clinical outcome, complications, and provisional results of meniscus centralization with medial meniscus root repair for the extruded medial meniscus at mean 2-year follow-up. Arthroscopy, 2024, 40(5): 1578-1587.
39. Yan X, Sahu S, Li H, et al. Arthroscopic meniscal posterior root repair combined with centralization reduces medial meniscus extrusion associated with posterior root tears: One-year clinical outcomes. Knee Surg Sports Traumatol Arthrosc, 2025, 33(8): 2825-2832.

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