Medial Meniscus Root Tears: Anatomy, Repair Options, and Outcomes

Meniscal root tears are defined as complete avulsions of the meniscus at the site of tibial attachment or meniscal tears within 1 cm of the meniscotibial attachment sites. This injury often is seen in individuals older than the age of 50 years who have a sedentary lifestyle and can lead to the progression of osteoarthritis if not treated properly; in contrast, a traumatic etiology may be observed in younger individuals. Recent literature has defined the association between medial meniscal root tears and meniscal extrusion, defined by >2 mm of overhang of the medial meniscus over the medial border of the tibial plateau. Surgical repair often is indicated for unstable meniscal root tears, as these injuries are functionally equivalent to a total meniscectomy because of a complete loss of circumferential fibers and hoop stresses. There are 2 main repair techniques: transtibial pullout and suture anchor repairs. Repair using the transtibial pullout technique involves drilling a tunnel from the anterior proximal tibia to the anatomic insertion site of the meniscal root. Sutures are then passed through the medial root, retrieved through the tunnel, and secured with a cortical button or suture anchor on the anterior tibial cortex. Suture anchor repairs either involve passing sutures through the meniscal root and into a suture anchor at the footprint. A supplemental centralization technique is a new advancement designed to reduce meniscal extrusion and involves fixation of the meniscal body with a suture anchor at the peripheral medial plateau. Medial meniscal root repair is associated with improved patient-reported outcomes and a reduced rate of knee replacement.