Meniscal Root Tears: Anatomy, Biomechanics, Diagnosis, and Surgical Management—A Comprehensive Review

Umile Giuseppe Longo; Beniamino Macaluso; Martina Nencini; Marco Meduri; Paolo Eugenio Ternullo; Sara Cupo; Alessandro de Sire; Pieter D’Hooghe

Abstract

Background: Meniscal root tears (MRTs), particularly those involving the posterior horns of the medial and lateral menisci, have become increasingly recognized for their significant biomechanical implications and their strong association with the onset and progression of knee osteoarthritis. These lesions disrupt the meniscus’s ability to convert axial loads into hoop stresses, leading to extrusion, altered joint mechanics, and accelerated cartilage degeneration. Purpose: This review aims to provide a comprehensive synthesis of current knowledge on the anatomy, biomechanics, epidemiology, clinical presentation, diagnosis, classification, treatment strategies, and surgical outcomes of meniscal root tears. Methods: A narrative literature review was conducted through a non-systematic search of PubMed, Scopus, and Web of Science, including peer-reviewed studies published primarily from 2000 to 2024. Additional landmark articles outside this range were also included for historical or foundational relevance. Selection focused on studies addressing the anatomy, biomechanics, diagnosis, and surgical management of meniscal root tears. Results: MMPRTs are more prevalent than LMPRTs and are typically degenerative in nature, affecting older, overweight females with varus alignment. LMPRTs are more commonly traumatic and frequently associated with anterior cruciate ligament (ACL) injuries. MRI remains the primary imaging modality, although arthroscopy remains the diagnostic gold standard. Surgical repair techniques, particularly transtibial pullout and suture anchor fixation, have demonstrated superior outcomes compared to conservative treatment or meniscectomy. Clinical and functional improvements, as well as reduced progression to osteoarthritis, have been reported, though healing rates vary. Conclusion: MRTs represent a significant clinical entity due to their biomechanical relevance and potential for irreversible joint degeneration. Early recognition and appropriate surgical intervention are effective for preserving joint function and improving long-term outcomes.

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