What are meniscal root tears and how should they be treated?

Some knee ligament injuries can be associated with tears of the medial or lateral meniscal root. The root is the part of the posterior horn of the meniscus where it attaches to the middle of the knee near the posterior cruciate ligament (PCL) insertion on the tibia. When the meniscal root is torn from the tibia, the meniscus is no longer adequately attached and its function is lost. An unrepaired meniscal root can lead to knee dysfunction and osteoarthritis in that compartment.

Meniscal root injuries are diagnosed by MRI and ultimately confirmed during surgery. The MRI must be high-quality with relatively thin slices to see the meniscal root attachment. In young patients with ligament injuries, meniscal root injuries are ideally repaired surgically.

Meniscal root injuries are also seen in patients in their 40s and 50s. These tears are more commonly degenerative and do not respond as well to repair. Since the tissue is often degenerative, repairs do not always heal. Patients can get relief from the removal of torn meniscus tissue, but these patients often already have some arthritis which can progress.

A case of meniscal root injury is demonstrated in the figures below. A 15-year-old soccer player was injured in a collision and the meniscus tear was diagnosed on MRI. The patient also sustained an injury to the medial collateral ligament (MCL), which healed well without surgery. The meniscal root was repaired by placing a suture in the meniscus and pulling the suture through a bone tunnel and fixing it to the tibia. The patient returned to playing soccer six months after surgery.

MRI of knee joint. Yellow arrow indicates meniscal root tear.  MRI of knee joint. Yellow arrow indicates meniscal root tear.  Arthroscopic view from within the knee joint during surgery. Yellow arrow indicates meniscal root tear.  Arthroscopic view of meniscal root tear being repaired surgically.  Arthroscopic view of meniscal root tear that has been successfully repaired surgically.

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