Evaluation, Treatment, and Outcomes of Meniscal Root Tears: A Critical Analysis Review

Abstract

Meniscal root tears or avulsions compromise the biomechanical function of the menisci to a greater extent than simple meniscal tears do. As such, if left untreated, root injuries render the menisci incapable of properly distributing axial load and resisting rotation and translation. The clinical diagnosis of meniscal root abnormalities may be difficult as the signs and symptoms typically associated with meniscal body injuries, such as mechanical locking and catching, may not be present in patients with root injury and there may not be a history of an acute traumatic event. Treating practitioners need to have a high suspicion for meniscal root abnormalities in patients presenting with joint line tenderness and pain with deep flexion activities. Magnetic resonance imaging (MRI) signs indicative of meniscal root abnormality include a radial tear of the meniscal root (on axial imaging), a vertical linear defect in the meniscal root (truncation sign on coronal imaging), meniscal extrusion >3 mm outside the peripheral margin of the joint (on coronal imaging), and increased signal within the meniscal root (ghost sign on sagittal sequences). Two main approaches for meniscal root repair have evolved. One approach involves the use of a transtibial pullout technique, and the other involves the use of a suture anchor repair. The goal of both approaches is to restore an anatomical attachment of the meniscal root to bone that is capable of converting axial weight-bearing loads into hoop stresses. In a recent systematic review of meniscal root repairs, healing (partial and complete) was reported to have occurred in 96% of cases, with all studies demonstrating improvements in terms of subjective and functional scores at a mean of 30.2 months postoperatively.