Shared versus independent tibial tunnels for lateral meniscus posterior root repair with ACL reconstruction: Comparable outcomes with shorter operative time in the shared tunnel technique at 2 years

Abstract Purpose Lateral meniscus posterior root (LMPR) tears frequently accompany anterior cruciate ligament (ACL) injuries and can compromise knee biomechanics and stability if left unrepaired. The primary research question was whether LMPR repair performed using a shared ACL tibial tunnel provides clinical, patient‐reported and magnetic resonance imaging (MRI) outcomes equivalent to those of an independent transtibial pullout technique. Methods A retrospective comparative study included 50 patients who underwent arthroscopic ACL reconstruction with concomitant LMPR repair between June 2019 and June 2022. Twenty‐four patients underwent LMPR repair using a shared ACL tibial tunnel technique and 26 patients underwent repair using an independent transtibial pullout technique. All procedures were performed by a single surgeon, with a minimum follow‐up of 2 years. Clinical assessment included Lachman grade, pivot‐shift grade, International Knee Documentation Committee (IKDC) score and Lysholm knee score. MRI evaluation assessed LMPR healing and lateral meniscus extrusion (LME). Results Mean operative time was significantly shorter in the shared tunnel group (73.50 ± 8.51 min) compared with the independent tunnel group (97.00 ± 8.39 min; p  < 0.001). Significant improvements in clinical stability and patient‐reported outcome measures were observed in both groups at 2‐year follow‐up ( p  < 0.001 for all within‐group comparisons), with no significant differences between groups. MRI‐based LMPR healing rates were comparable ( p  = 0.231). Both groups demonstrated significant reductions in LME at follow‐up ( p  < 0.001), with no significant difference between techniques ( p  = 0.181). Conclusion LMPR repair using a shared ACL tibial tunnel yields clinical, patient‐reported and MRI outcomes comparable to those of an independent transtibial pullout technique, while significantly reducing operative time. By avoiding an additional tibial tunnel, this technique preserves bone stock, prevents tunnel convergence and eliminates the need for an extra implant, making it a safe, efficient and cost‐effective option when combined with arthroscopic ACL reconstruction. Level of Evidence Level III, retrospective comparative study.