AANA Lab Course 913 - Advanced Knee Course-Root Tears_ Current Treatment Concepts for 2019 Faculty Lecture

Root Tears_ Current Treatment Concepts for 2019 Faculty Lecture_ Robert F. LaPrade, MD PhD

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This 2019 presentation by Dr. Robert F. LaPrade highlights meniscal root tears as a significant and often underdiagnosed knee injury with serious consequences if untreated. Previously considered rare, meniscal root tears, including radial root tears near the attachment site, are now recognized as more common and frequently missed on MRI and arthroscopy. These injuries disrupt the meniscus’s ability to distribute hoop stress, leading to meniscal extrusion, cartilage damage, joint space narrowing, and rapid osteoarthritis (OA) progression.<br /><br />Research emphasizes understanding the anatomy, biomechanics, and accurate diagnosis of root tears to guide anatomic repair techniques. Medial meniscal posterior horn (PH) root tears simulate total meniscectomy biomechanically, drastically increasing joint contact pressures and instability. Anatomical repair restores contact area and pressure, minimizing OA risk. Similarly, lateral meniscal root tears are common with ACL injuries and contribute to rotational instability and anterior tibial translation—"think LM root with ACL injuries."<br /><br />Optimal treatment involves transtibial pullout repair through one or two tibial tunnels, which allows precise anatomic fixation and may enhance healing biologically. Rehabilitation includes non-weight bearing for 6 weeks, limited range of motion, and gradual loading avoiding deep squats to protect the repair.<br /><br />Clinical outcomes are encouraging—systematic reviews show improved function, high rates of healing, and limited OA progression at about 2.5 years post-repair. Nonoperative management often fails, with many patients eventually requiring total knee arthroplasty.<br /><br />In conclusion, meniscal root tears are a “silent epidemic” requiring prompt recognition and repair to restore knee mechanics and prevent rapid degenerative changes. Dr. LaPrade stresses that meniscal root repair is critical for preserving joint health and recommends anatomic repair whenever feasible.

Keywords

meniscal root tears

knee injury

meniscal extrusion

osteoarthritis progression

anatomic repair

medial meniscal posterior horn

lateral meniscal root tears

transtibial pullout repair

ACL injuries

rehabilitation protocols