Abstract:Objective This study aims to evaluate the biomechanical effectiveness of tendon reconstruction (TR) for repairing medial meniscus posterior root tear (MMPRT). Through vitro experiments, biomechanical data were collected for the transtibial pullout suture (TPS), tendon reconstruction (TR), and tendon reconstruction with suture augmentation (TRS) to provide clinical references. Methods Eighteen porcine knee joint models were divided into three groups: TPS, TR, and TRS. TPS: Sutures were used to fix the meniscal root.TR : Tendons were passed through an incision at the meniscal root. TRS : Tendons were passed through an incision at the meniscal root and secured at tendon-meniscus contact area with additional sutures.The sutures and tendons were pulled out through tibial tunnels and fixed at the anteromedial tibia. All groups underwent failure load testing, with the following parameters recorded: ultimate failure load, displacement at failure load, load at clinical failure, stiffness, and failure modes. Results The ultimate failure load in the TPS was significantly higher than in the TR(P<0.05) but showed no significant difference compared to the TRS (P > 0.05). The ultimate failure load in the TRS was significantly higher than in the TR (P < 0.05).The displacement at failure load in the TR and TRS was significantly lower than in the TPS (P < 0.05), but there was no significant difference between the TR and TRS (P > 0.05).There were no significant differences in the load at clinical failure among the groups (P > 0.05).The stiffness of the TRS was significantly greater than that of the TPS (P < 0.05), but no significant difference was observed between the TR and TPS ,as well as between TR and TRS (P > 0.05)..All failures were caused by suture or tendon cutting through the meniscus. Conclusion The tendon reconstruction techniques is superior to the TPS in terms of failure displacement and stiffness,while the TRS further enhances the stability of the repair, providing important clinical reference.