Meniscus Medial Posterior Root Tear Management

Medial meniscus posterior root tear (MMPRT) refers to the avulsion or complete radial tear occurring within a distance of 1 cm from the posterior tibial attachment of the medial meniscus. Root tears result in the extrusion of the meniscus, which subsequently leads to elevated joint contact pressures. These condition increased pressures contribute to the rapid progression of joint space narrowing and the occurrence of subchondral bone edema that were indistinguishable from total meniscectomy. Studies have reported that MMPRT represents A substantial percentage of meniscus tears, accounting for approximately 10 to 20% of all meniscus tears diagnosed. MMPRT frequency was reportedly 21.5% in all arthroscopic surgeries for meniscus medial tear. Nevertheless, despite the significant role that these injuries play in the development of degenerative joint disease, they frequently remain undetected during the initial evaluation. MMPRT are relatively common among middle-aged adults, female sex, and higher BMI with clear onset of significant injury. This might be attributed to aging associated degenerative alteration that makes the meniscus more susceptible to root detachment. The primary objective of managing MMPRT is to mitigate the progression of osteoarthritis by reinstating optimal joint contact pressures and kinematics. Given the unfavourable results observed with conservative treatment, surgical repair is currently regarded as the preferred choice. This approach has demonstrated encouraging clinical outcomes specifically in patients who meet the appropriate indications. Patients undergoing medial meniscus root repair have better functional scores, less osteoarthritis progression, and less conversion to total knee replacement compared to meniscectomy. The most common repair method for MMPRT is using transtibial pull-out repair at anatomic footprint of the meniscus root. Nevertheless, the pull-out suture method exhibits a vulnerability at the location of meniscus suturing, where cuts frequently occur during cyclical loading. Additionally, this technique cannot restore the meniscus extrusion. Furthermore, directly repair of the meniscus to bone may lead to a biologically weak structure at the footprint of the meniscus root. Nonanatomical repair itself shows less tibiofemoral contact area and increased mean contact pressure compared to anatomic repair. Several additional procedures have been proposed to maximize the result of meniscus root repair, including peripheral meniscocapsular release, centralization suture, and root reconstruction to minimize meniscus extrusion. In case of a significant tear gap found, root reconstruction is recommended to address the gap.