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. 2025 Jul 3:S0749-8063(25)00479-7.
doi: 10.1016/j.arthro.2025.06.028. Online ahead of print.

International Delphi Consensus on Medial Meniscal Root Tears Shows High Agreement on Diagnosis, Treatment, and Rehabilitation but Lack of Agreement on Treatment of Asymptomatic Tears

Jorge Chahla  1 , Jose Rafael Garcia  2 , Luke Tollefson  3 , Lika Dzidzishvili  4 , Felicitas Allende  5 , Cameron Gerhold  6 , Aaron J Krych  7 , Robert F LaPrade  3 ; Meniscus Root International Expert Group
Collaborators, Affiliations

International Delphi Consensus on Medial Meniscal Root Tears Shows High Agreement on Diagnosis, Treatment, and Rehabilitation but Lack of Agreement on Treatment of Asymptomatic Tears

Jorge Chahla et al. Arthroscopy. .

Abstract

Purpose: To develop an expert consensus statement on the diagnosis, management, and rehabilitation of medial meniscal root tears (MMRTs) using a modified Delphi technique.

Methods: A working group developed statements on MMRT diagnosis, nonoperative management, surgical indications, surgical management, alignment, and rehabilitation using modified Delphi techniques. Fifty-six experts were surveyed over 3 rounds to reach consensus, with agreement measured on a 5-point Likert scale. Statements were included, revised, or excluded on the basis of predefined thresholds (≥75% agreement, <20% disagreement). Experts suggested revisions or new statements in the first 2 rounds, and final consensus statements were included.

Results: All 56 experts completed 3 survey rounds. Experts agreed that root tears may occur with no known history of trauma, typically in older patients, and that it should be diagnosed with an magnetic resonance imaging. In symptomatic patients with MMRTs without advanced osteoarthritis should be repaired using an anatomic transtibial pull-out technique (performing a pie-crusting technique can be helpful for visualization). Nonoperative management is advised for patients with advanced osteoarthritis. High tibial osteotomy may be considered for significant varus malalignment during MMRT repair. The only statement without consensus was the management of asymptomatic MMRTs with mild medial compartment cartilage wear, indicating ongoing debate.

Conclusions: Overall, 98% of statements reached consensus. There is agreement that magnetic resonance imaging is the gold standard for diagnosis. Symptomatic MMRTs without advanced osteoarthritis should be repaired early using an anatomic transtibial pull-out technique. End-stage knee osteoarthritis warrants nonoperative management of MMRTs, and a structured postoperative protocol with limited weightbearing and range of motion is essential after repair. No agreement was reached on managing asymptomatic MMRTs in patients without significant medial compartment degeneration. Meniscal centralization sutures may help in cases of substantial extrusion, but their routine use is debated.

Level of evidence: Level V, consensus of expert opinion.

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Conflict of interest statement

Disclosures The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: B.B. received payment for lectures/faculty involvement from Smith & Nephew and Ortomedic and is in the board/editorial boards of European Society of Sports Traumatology, Knee Surgery and Arthroscopy, Journal of ISAKOS, Knee Surgery, Sports Traumatology, Arthroscopy, American Journal of Sports Medicine, and Video Journal of Sports Medicine. J.C. reports board or committee member, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine; paid consultant for Arthrex, CONMED Linvatec, Ossur, and RTI Surgical; hospitality payments from Breg, DePuy Synthes Sales, Joint Restoration Foundation, Medical Device Business Services, Pacira Pharmaceuticals Incorporated, and SI-Bone; educational support from Midwest; paid consultant; paid presenter or speaker Associates for Smith & Nephew; and paid consultant, hospitality payments from Vericel Corporation. C.M.L. reports other financial or material support from Arthrex; paid presenter or speaker for DJ Orthopaedics; paid consultant and IP royalties from Ossur; and IP royalties, other financial or material support from, and paid consultant for Smith & Nephew. A.G.G. has received consulting fees from Smith & Nephew, speaking fees from Ossur and Arthrex, and support for education from Stryker Corporation and Medwest Associates. A.G. reports editorial or governing board of the American Journal of Sports Medicine and Knee Surgery, Sports Traumatology, Arthroscopy; IP royalties from Graymont; board or committee member of the International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine; stock or stock options from LinkX Robotics; Ostesys Robotics; Precision OS; Smart HTO; Spring Loaded Technologies, and Surgical Health Innovations Corp; paid consultant, paid presenter or speaker, and research support from Smith & Nephew and research support from Ossur. D.L.J. reports board or committee member, American Orthopaedic Society for Sports Medicine and Southern Orthopaedic Association; research support from DJ Orthopaedics and Smith & Nephew Endoscopy; publishing royalties, financial or material support from Elsevier; editorial or governing board of Journal pf Surgical Orthopaedic Advances, Orthopedics, Orthopedics Today, Sports Medicine and Arthroscopy Review, and SLACK Incorporated; IP royalties from Smith & Nephew; and paid consultant for Smith & Nephew Endoscopy. A.K. reports editorial or governing board of the American Journal of Sports Medicine and Springer; IP royalties from and paid consultant for Arthrex; and board or committee member of the Arthroscopy Association of North America and the International Cartilage Repair Society. R.F.L. reports consulting or advisory with Ossur Americas, Smith & Nephew, Linvatec Europe, and Responsive Arthroscopy and funding grants from Ossur Americas, Smith & Nephew, Arthroscopy Association of North America, and American Orthopaedic Society for Sports Medicine. M.L. reports educational services for Smith & Nephew. T.L. reports paid presenter or speaker for Arthrex; board or committee member of the International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine; paid consultant and paid presenter or speaker for Medacta; and paid consultant, paid presenter or speaker, and research support from Smith & Nephew. D.P. reports board or committee member of the ACL Study Group, Asia Pacific Knee Arthroscopy and Sports Medicine Society, and Asia Pacific Knee Society, and International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine; editorial or governing board of the American Journal of Sports Medicine, Orthopaedic Journal of Sports Medicine, Journal of ISAKOS, and SMARTT Journal; stock or stock options; unpaid consultant for Ganymed Robotics; stock or stock options from Personalised Surgery; paid consultant; paid presenter or speaker for Smith & Nephew; and research support from Zimmer. W.P. reports paid presenter or speaker for Arthrex and Geistlich; board or committee member of Deutsche Kniegesellschaft and GOTS; IP royalties from Karl Storz; editorial or governing board of Kniejournal; and paid consultant for OPED, Valley, Germany. R.S. reports paid presenter or speaker for Arthrex and Smith & Nephew and editorial or governing board of Knee Surgery, Sports Traumatology, Arthroscopy. B.S-C. reports stock or stock options with AREAS and IP royalties from and paid consultant for Arthrex. T.S. reports IP royalties from and paid presenter or speaker for CONMED Linvatec; paid consultant and paid presenter or speaker for Episurf; board or committee member of the ICRS Cartilage Foundation; paid presenter or speaker for Joint Operations UK; editorial or governing board of Knee Surgery, Sports Traumatology, Arthroscopy; paid consultant for and stock or stock options from Orthonika; and paid presenter or speaker for Smith & Nephew. M.J.S. reports paid consultant for and receives royalties from Arthrex and has received research support from Stryker. S.T. reports consulting or advisory with Smith & Nephew and Newclip Technics. M.T. reports board membership with International Society of Arthroscopy Knee Surgery and Orthopaedic Sports Medicine and consulting or advisory with Arthrex. N.N.V. reports hospitality payments from Abbott Laboratories, Axonics, Boston Scientific, Foundation Fusion Solutions LLC, IBSA Pharma, Nalu Medical, Nevro Corp, Orthofix Medical, Pacira Pharmaceuticals Incorporated, Relievant Medsystems, Salix Pharmaceuticals, Vericel Corporation, and Vertos Medial; board or committee member of the American Orthopaedic Society for Sports Medicine, American Shoulder and Elbow Surgeons, and Arthroscopy Association of North America; IP royalties; research support from Arthrex and Smith & Nephew; research support from Breg and Ossur; IP royalties from Graymont Professional Products IP LLC; paid consultant for Medacta USA; educational support from Medwest Associates; editorial or governing board of SLACK Incorporated; travel and lodging from Spinal Simplicity LLC:; and IP royalties, paid consultant, and research support from Stryker. A.Y. reports paid consultant for AlloSource and JRF Ortho; research support from Arthrex and Organogenesis; stock or stock options from Icarus Medical; unpaid consultant and stock or stock options from Patient IQ and Sparta Biomedical; and paid consultant and paid presenter or speaker for Stryker. V.M. reports board or committee member of the ACL Study Group, American Orthopaedic Society for Sports Medicine, International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine, and Journal of ISAKOS; other financial or material support from Arthrex; editorial or governing board of Knee Surgery, Sports Traumatology, Arthroscopy: paid consultant for Newclip; stock or stock options from Ostesys; other financial or material support from and paid consultant for Smith & Nephew; and publishing royalties, financial or material support from Springer. All other authors (F.A., L.D., J.R.G., C.G., A.J.B., D.L.B., C.H.B., K.S.C., M.C., L.E., F.F., S.C.F., M.J.F., T.F., T.H., E.I., J.G.K., Y.K., E.K., S.K., C.M.L., D.W.L., C.A.L., I.I.L.T., R.M., G.M., J.K.M., R.N.V., Y.O., J.C.R., E.S., C.S., S-H.K., M.J.T., L.V.T., W.A.v.d.W., R.P.B.v.B.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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