The purpose of the present study was to compare the clinical outcomes of patients who underwent an all-inside repair (with a bony trough) versus transtibial pull-out repair in medial meniscus posterior root tears (MMPRTs). We retrospectively investigated consecutive patients who underwent MMPRT repairs in nonacute tears in age over 40 from November 2015 to June 2019. All patients were divided into a transtibial pull-out repair group and an all-inside repair group. Different surgical techniques were used during different time frames. All patients were followed-up for a minimum of 2 years. The data collected included the International Knee Documentation Committee (IKDC) Subjective, Lysholm, and Tegner activity scores. Magnetic resonance imaging (MRI) was performed at the 1-year follow-up to assess meniscus extrusion, signal intensity, and healing. The final cohort consisted of 28 patients in the all-inside repair group and 16 in the transtibial pull-out repair group. In the all-inside repair group, the IKDC Subjective, Lysholm, and Tegner scores improved significantly at the 2-year follow-up. In the transtibial pull-out repair group, the IKDC Subjective, Lysholm, and Tegner scores did not improve significantly at the 2-year follow-up. Postoperative extrusion ratio increased in both groups, and patient-reported outcomes at follow-up did not differ between the two groups The change in the extrusion ratio was significantly less in the all-inside repair group (P = .009), as was the postoperative meniscus signal (P = .011). Postoperative MRI revealed significantly better healing in the all-inside group (P = .041). All-inside repair improved the functional outcome scores. Radiologically, all-inside repair was better than transtibial pull-out repair. All-inside repair may be a viable MMPRT treatment option. III, retrospective cohort study.