Arthroscopic repair of meniscal root tears: Current evidence and future directions

Meniscal root tears (MRTs) represent a distinct subset of meniscal injuries with profound biomechanical and clinical implications. Disruption of the meniscal root compromises hoop-stress transmission, resulting in a functional meniscectomy state characterized by increased tibiofemoral contact pressures, progressive meniscal extrusion, and accelerated articular cartilage degeneration, ultimately predisposing to early osteoarthritis if left untreated. Medial posterior root tears typically affect middle-aged patients and are commonly associated with varus alignment and medial compartment overload, whereas lateral root tears frequently occur in conjunction with anterior cruciate ligament injuries. Magnetic resonance imaging plays a crucial role in diagnosis, with characteristic findings including the ghost sign, truncation of the posterior horn, and meniscal extrusion of 3 mm or more, while arthroscopy remains the gold standard for definitive assessment of tear morphology and associated intra-articular pathology. Contemporary management has shifted toward joint-preserving strategies, emphasizing anatomic meniscal root repair to restore native biomechanics. Transtibial pull-out techniques and suture-anchor fixation are the most commonly employed methods, with adjunctive procedures such as meniscal centralization and selective biologic augmentation increasingly utilized to enhance healing. In selected cases of symptomatic medial MRTs with varus malalignment, concomitant high tibial osteotomy may be performed to unload the medial compartment and protect the repair. Early recognition and appropriate anatomic repair are essential for optimizing functional outcomes and long-term joint preservation.