Background: Damage to the medial meniscus root, destroyed knee to withstand hoop strain abilities, came from increasing the contacting pressures and osteoarthritis progression and kinematic alterations. Many techniques were developed for repairing medial meniscus posterior root tear (MMPRT), Available surgical techniques were proved to failed on reducing meniscus extrusion and associated with osteoarthritis developing, despite improving which observed in postoperative clinical were achieve. Technical Note was described as arthroscopic technique for the medial meniscus posterior root tear and repair was augmented by centralization technique to restored and maintaining medial meniscus function by reduced meniscus extrusion. Patients and Methods: Thirty patients presented with posterior root tear of medial meniscus managed arthroscopically by Trans-tibial pull-out technique. Results: Between March 2018 and July 2019, 30 patients aged from 25-55 years, were operated, lysholm score increase from 56.5 ± 10.34 preoperative to 78.25 ± 7.13 after 3 months postoperative and increase to 89 ± 8.16 at last follow up visit. Conclusion: Arthroscopic repairing medial meniscus posterior root tears using Trans-osseous pull out sutures techniques showed significant improvement to the studied population in terms of functional knee scores (Lysholm and Tegner) and meniscal integrity.