Meniscal root repair is an arthroscopic operation to reattach a torn meniscal root — the anchor point where the meniscus attaches to the tibial plateau. A root tear functionally converts the meniscus to a meniscectomy, causing rapid loss of hoop stress function.
Performed arthroscopically. The torn root is identified. Strong sutures are passed through the meniscal root. A bone tunnel is drilled through the tibial plateau. The sutures are pulled through the tunnel and tied over a button on the anterior tibia, pulling the root back to its anatomical attachment. The operation takes 45–90 minutes.
Root tears cause loss of meniscal function equivalent to total meniscectomy, leading to rapid arthritis. Repair is recommended for acute or subacute root tears with minimal or no arthritis, particularly medial meniscal posterior root tears and lateral meniscal root tears associated with ACL injury.
Physiotherapy and observation — accepting progressive arthritis. Partial meniscectomy does not restore root function. High tibial osteotomy may protect the compartment if the medial root cannot be repaired.
MRI showing root tear (the 'ghost sign' — absent meniscal attachment on sagittal images). Standing X-rays to assess for existing arthritis. Patient counselling about the protected rehabilitation.
Restoration of meniscal root attachment and hoop stress function. Prevention or slowing of articular cartilage degeneration. Healing rates approximately 70–85%.
Non-weight-bearing for six to eight weeks.
Temporary loss of deep flexion.
The root may not heal completely, though partial healing still provides benefit.
The repaired root may fail.
Bone tunnel fracture or widening.
Joint infection.
Despite repair, some cartilage damage may have already occurred.
General or spinal anaesthesia.
Non-weight-bearing for six to eight weeks. No deep squatting for four months. Physiotherapy for quadriceps strengthening and range of motion. Running at four to six months. Return to sport at six to nine months.
Reviews at two weeks, six weeks, three months, and six months. MRI at six months to assess healing.
The meniscal root is the bony attachment point where the C-shaped meniscus anchors to the tibial plateau. Without this anchor, the meniscus cannot generate hoop stresses — it essentially becomes functionless, equivalent to having no meniscus at all.
Root tears are biomechanically devastating — they cause loss of all meniscal function in that compartment, leading to much faster arthritis progression than typical peripheral or body tears.