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Both the medial and lateral menisci have a stout attachment at their very posterior aspects, which are called the root attachments. These root attachments are important because they hold the meniscus in place, provides stability to the circumferential hoop fibers of the meniscus, and prevents meniscal extrusion.
When there is a tear of the meniscal root, it has been demonstrated on biomechanical testing that it is equivalent to having the whole meniscus removed. Thus, a tear of the meniscal root is considered a very serious condition.
Coronal view MRI scan demonstrating a posterior horn medial meniscus root tear. The meniscus is torn off its attachment site and tends to sublux posteromedially. This meniscal extrusion can lead to a nonfunctional medial meniscus and the early development of osteoarthritis.
Meniscal Root Tear Meniscal root tears can be seen on coronal, axial and sagittal MRI views. On the sagittal view, as seen in Figure C, there is a “ghost sign” which is indicative of meniscal root tear. A normal, healthy meniscus should look like a dark black triangle; however, as this figure shows the meniscus is much lighter or “ghosted” representing the root tear.
Sagittal MRI view of a meniscal root tear.
Sagittal MRI view there is a “ghost sign” which is indicative of meniscal root tear.
The treatment of meniscal root tears in older patients can be very difficult. This is because they are not commonly diagnosed until the progression of arthritis is more severe. Due to the increasing knowledge that these tears can lead to rather progressive arthritis, one should consider an attempt at a meniscal root repair at the first signs of the development of pain and swelling with activities, which usually indicates the progression of arthritis, joint space narrowing, or any bony edema of the affected compartment on MRI scans. A concurrent distal femoral or proximal tibial osteotomy may also be indicated if the patient is malaligned to unload the affected compartment.
Meniscal root tears have only been noted as a significant pathology over the last 5 to 6 years. Research into the problem is ongoing. Our lab has noted that radial tears adjacent to the root attachment, known as a radial root tear, can also cause the same problems as a meniscal root avulsion of the attachment site. Our studies have also demonstrated that repairs of these radial root tears can restore fairly normal weightbearing characteristics and load sharing of the affected compartment. Thus, in properly selected patients, a radial root repair would also be indicated.
Patients who have a meniscal root repair need to be non-weightbearing for 6 weeks after surgery. Physical therapy is initiated on the first day after surgery. Patients are limited in moving their knees to 90 degrees of knee flexion for the first two weeks after surgery and then after this time they may increase their knee motion. At six weeks after surgery, a partial protective weight bearing program is initiated and patients may slowly wean off crutches when they can ambulate without a limp. The use of a stationary bike may be also started. Patients should avoid impact activities, deep squats, squatting and lifting, and sitting cross-legged for a minimum of 4 months after surgery to protect the meniscus root repair.