Understanding Meniscal Root Tears Properly

Today, the doctor performed surgery on a young male patient with an anterior cruciate ligament tear and a lateral meniscus root tear. Athletes are often terrified when they hear about meniscus tears, but people may not fully understand all the morphological types of meniscus tears. Among them, a meniscus root tear is a very distinct and dangerous type of injury. Let's read and learn about this injury with the doctor.

Meniscus root tears (MRTs) are characterized by radial tears within 1 cm of the anterior or posterior meniscotibial attachment site or by complete detachment of the meniscus from its tibial insertion. Historically, these lesions have been underdiagnosed and underestimated, but they have received significant attention in recent years.

The menisci play a crucial role in the function and biomechanics of the knee joint. They act as shock absorbers by distributing forces and converting axial loads into radial hoop stresses, commonly referred to as hoop stress. Anchoring the meniscus to the tibial plateau and preventing extrusion of the meniscus during joint loading reduces the impact of compressive forces, thereby protecting the knee joint from potential degenerative joint changes.

Meniscus root tears typically occur posteriorly rather than anteriorly, presenting in two clinical settings: degenerative and traumatic.

Posterior root tears of the medial meniscus are usually associated with degenerative joint disease, more commonly seen in females, obese individuals, those over 50 years of age, individuals with sedentary lifestyles, those who frequently squat or kneel, and predominantly in Middle Eastern and Asian populations. Conversely, lateral meniscus root tears are commonly traumatic, frequently associated with anterior cruciate ligament (ACL) injuries in young patients with multiligamentous injuries and active lifestyles.

The management of MRTs depends on several factors, including the severity of the injury, the time from injury, and the status of the articular cartilage. Given the critical role of the meniscus in preserving articular cartilage, meniscus preservation should always be the primary goal. There are three main treatment options for MRTs: conservative management, partial meniscectomy, and surgical repair.

For young patients or older patients with mild-to-moderate osteoarthritis, arthroscopic repair of the meniscus root is the primary treatment of choice. The main techniques used to fix posterior meniscus roots are suture anchor fixation and transtibial pull-out repair. The transtibial pull-out repair technique is considered the gold standard method because it provides better anatomical restoration, which is crucial for restoring meniscus stability and knee kinematics.

In this patient, the doctor performed an "all-inside" anterior cruciate ligament reconstruction using autologous hamstring tendons and a transtibial repair of the lateral meniscus root. Both procedures were performed arthroscopically through small, cosmetically appealing incisions. Let's wait another 3 months to see how the patient recovers.

References and Citations

Hantouly AT, Aminake G, Khan AS, et al. Meniscus root tears: state of the art. Int Orthop. 2024;48(4):955-964. doi:10.1007/s00264-024-06092-w