Meniscus root tears: state of the art

Abstract

Background: Meniscus root tears represent significant pathology that, historically, has been underdiagnosed and undertreated. However, the recognition of their clinical and functional significance has recently surged, mainly due to their frequent association with anterior cruciate ligament injuries.

Aim: This comprehensive review discusses various aspects of meniscal root tears, including their epidemiology, biomechanics, etiology, clinical and radiological findings, classification, management and surgical techniques.

Keywords: Anterior root; Knee; Meniscus root; Posterior root; Root repair.

Fig. 1

Direct and indirect MRI signs of meniscal root tears. T2 MRI images showing A high signal in the region of meniscus root and posterior horn on axial images; B Cleft sign; C Ghost sign and subchondral edema on sagittal image; and D meniscus extrusion on coronal image

Fig. 2

Cadaveric photograph of the knee showing the medical meniscus and its posterior root

Fig. 3

Laprade’s arthroscopic morphological meniscal root classification system [34]. Type 1: Stable partial tear. Type 2A: Full tear within 3 mm of root attachment. Type 2B: Full tear within 3–6 mm of root attachment. Type 2B: Full tear within 6–9 mm of root attachment. Type 3: Full tear with bucket handle tear. Type 4: Complex oblique full tear. Type 5: Root bony avulsion [34]

Fig. 4

Meniscus root tears treatment algorithm

Fig. 5

Single tunnel transtibial fixation of medial meniscal root tear. a Preparation of the root attachment site by promoting bleeding at the root bed using a curette. b Pulling the root to its anatomic attachment site. c, d Drilling an ipsilateral single transtibial tunnel using meniscal root or ACL guide. e Two luggage tag sutures or looped sutures are placed in the detached root and then retrieved using a suture passer. f Sutures are secured on the anterior aspect of the tibia using a button. g, h Axial and sagittal views of the final fixation, respectively

Fig. 6

Arthroscopic images of a tear of the posterior horn of the medial meniscus (PHMM) and its repair. a Tear of the posterior horn of the medial meniscus. b The guide is placed in the anatomical position of the PHMM to steer the transtibial drilling. c, d Two luggage tag sutures are passed through the meniscal root under arthroscopic visualization and then passed through the transtibial tunnel

Fig. 7

Single tunnel transtibial centralization of the medial meniscus. a, b Drilling an ipsilateral single transtibial tunnel using meniscal root or ACL guide. c Two luggage tag sutures are placed in the body of the meniscus and then retrieved using a suture passer. d Sutures are secured on the anterior aspect of the tibia using a button. e, f Axial and sagittal views of the final fixation, respectively