AOSSM/AANA Specialty Day 2020-Root Tears_ How to and Who to Fix in 2020

Root Tears_ How to and Who to Fix in 2020_

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This presentation by Dr. Nicholas Sgaglione from the Zucker School of Medicine reviews meniscus root tears, focusing on the types, indications for repair, surgical techniques, and clinical outcomes.<br /><br />Meniscus root tears affect the meniscal attachment to the tibia and are increasingly recognized, with a bimodal age distribution (around 22 and 52 years old). Medial root tears are more common in older patients with higher BMI and more joint degeneration, while lateral root tears tend to occur in younger patients with less degeneration, often linked to ACL injuries.<br /><br />Diagnosis relies on MRI findings such as extrusion, ghosting, bone edema, and arthroscopic visualization. Classification has evolved, differentiating types by location and tissue viability. Not all tears require repair; indications include clinical symptoms, cartilage damage (Grade 3 Outerbridge or Grade 2 Kellgren-Lawrence), varus malalignment, and patient compliance with rehabilitation. Factors influencing repair decisions include age, BMI, extrusion, alignment, and patient goals.<br /><br />When repair is not planned, meniscectomy (resection) may be considered if alignment is good and arthritis mild; however, partial meniscectomy often does not prevent progression to knee replacement, especially in females, high BMI, and with extrusion. Studies show no significant difference in long-term radiographic outcomes between meniscectomy for posterior horn and root tears.<br /><br />Preferred repair technique is the transtibial pullout method with double locking looped sutures or suture tape to restore the meniscal footprint. Medial collateral ligament (MCL) release can improve access without causing residual instability. Postoperative rehab includes protected weight-bearing and controlled range of motion.<br /><br />Outcomes of root repair show good functional scores, low revision rates, and delayed progression to knee replacement, with better results when extrusion and joint space narrowing are minimal. Age or medial vs lateral tear does not greatly affect outcomes, but BMI and alignment do.<br /><br />In summary, stratifying patients based on clinical and imaging factors helps identify who benefits from repair. Surgical technique and rehab protocols are critical to optimize outcomes, potentially delaying osteoarthritis progression and knee replacement.

Keywords

meniscus root tears

meniscal attachment

tibial meniscus

medial root tears

lateral root tears

MRI diagnosis

transtibial pullout repair

meniscectomy outcomes

postoperative rehabilitation

knee osteoarthritis progression