Meniscal Root Tears: A State of the Art

Area of Science:

• Orthopedics
• Sports Medicine
• Biomechanics

Background:

• Meniscal root tears are biomechanically distinct injuries with high prevalence, often underdiagnosed.
• These tears disrupt hoop stress transmission, leading to tibiofemoral contact changes similar to total meniscectomy.
• Consequences include meniscal extrusion, cartilage degeneration, and early osteoarthritis.

Purpose of the Study:

• To provide a comprehensive review of meniscal root tear anatomy, biomechanics, epidemiology, and management.
• To synthesize current evidence on diagnosis, surgical techniques, and outcomes.
• To identify future research directions for optimizing patient care.

Main Methods:

• Literature review of studies on meniscal root tears.
• Synthesis of data on epidemiology, clinical presentation, and diagnostic modalities.
• Analysis of treatment outcomes comparing surgical repair, partial meniscectomy, and non-operative management.
• Review of emerging techniques and future research directions.

Main Results:

• Two distinct populations exist: older, obese patients with degenerative posterior medial root tears and younger, active patients with lateral posterior root tears associated with ACL injuries.
• Diagnosis relies on high clinical suspicion and MRI, as physical exam findings are often nonspecific.
• Surgical repair, particularly transtibial pullout fixation, demonstrates superior functional outcomes and reduced osteoarthritis progression compared to other treatments.
• Current meniscal centralization techniques have limitations in correcting persistent extrusion.

Conclusions:

• Meniscal root tears are a significant cause of knee dysfunction and early osteoarthritis.
• Surgical repair is the preferred treatment for symptomatic patients with preserved joint space.
• Further research is needed to standardize patient selection, enhance repair healing, and refine rehabilitation protocols.