Forty patients with medial meniscus posterior root tears were randomized to undergo arthroscopic transtibial pullout repair (n = 20) or all-inside repair (n = 20). Clinical outcomes were assessed using IKDC, Tegner activity, Lysholm scores, and active range of motion (AROM) of knee flexion, along with operative time, time to ambulation, hospital stay, and complications. Outcomes were evaluated preoperatively and at final postoperative follow-up (timepoint not clearly specified). Overall, the results of the study revealed that both procedures significantly improved knee function, but the transtibial pullout technique produced higher postoperative IKDC (52.82 vs 46.43), Tegner (7.69 vs 5.96), and Lysholm (84.41 vs 79.32) scores (all p < 0.01), albeit with a slightly longer operative time and more wound-related complications. These findings suggest that transtibial pullout repair may offer superior functional recovery compared with all-inside repair, while both techniques appear similarly reliable in avoiding re-tears.