➢ Meniscal root tears or avulsions compromise the biomechanical function of the menisci to a greater extent than simple meniscal tears do. As such, if left untreated, root injuries render the menisci incapable of properly distributing axial load and resisting rotation and translation.
➢ The clinical diagnosis of meniscal root abnormalities may be difficult as the signs and symptoms typically associated with meniscal body injuries, such as mechanical locking and catching, may not be present in patients with root injury and there may not be a history of an acute traumatic event. Treating practitioners need to have a high suspicion for meniscal root abnormalities in patients presenting with joint line tenderness and pain with deep flexion activities.
➢ Magnetic resonance imaging (MRI) signs indicative of meniscal root abnormality include a radial tear of the meniscal root (on axial imaging), a vertical linear defect in the meniscal root (truncation sign on coronal imaging), meniscal extrusion >3 mm outside the peripheral margin of the joint (on coronal imaging), and increased signal within the meniscal root (ghost sign on sagittal sequences).
➢ Two main approaches for meniscal root repair have evolved. One approach involves the use of a transtibial pullout technique, and the other involves the use of a suture anchor repair. The goal of both approaches is to restore an anatomical attachment of the meniscal root to bone that is capable of converting axial weight-bearing loads into hoop stresses.
➢ In a recent systematic review of meniscal root repairs, healing (partial and complete) was reported to have occurred in 96% of cases, with all studies demonstrating improvements in terms of subjective and functional scores at a mean of 30.2 months postoperatively.
Understanding of the meniscal root and its importance to normal meniscal function has evolved in the last 5 to 10 years, resulting in an improved ability to adequately identify and address this unique type of meniscal injury. The limitations currently preventing better understanding of meniscal root tears include lack of physician awareness, diagnostic difficulty, evolving indications for and contraindications to surgical repair, technical difficulty, and limited clinical follow-up data. What has been borne out by the existing literature is that healed meniscal root repairs restore meniscal continuity, thereby restoring the ability of the meniscus to generate hoop stresses as a means of resisting axial loads. The present article provides a critical analysis review of the available literature on the evaluation and treatment of meniscal root tears and assesses the indications for surgical intervention, techniques for operative repair, and the outcomes reported following meniscal root repair.
Anatomy and Biomechanical Impact of Root Tears
The integrity of the meniscus of the knee is essential for the preservation of the long-term function of the joint and the prevention of arthrosis1-11. The meniscus functions by augmenting tibiofemoral congruity and distributing axial loads12. The function of the meniscus is dictated by its structure and composition. The meniscus is composed of water, collagen (primarily Type I), and proteoglycan13. Macroscopically, these tissue components form 2 crescent-shaped structures located at the periphery of the medial and lateral tibiofemoral compartments. The superior aspect of each meniscus is concave to accommodate the convexity of the distal part of the femur. The inferior surface of the meniscus is relatively flat to match the flatter tibial plateau2. Microscopically, these tissue components are organized in such a way as to provide the menisci with the ability to dissipate axial loads by conversion to hoop stresses, especially when the knee is in full extension and deep flexion13. Secure attachment of the menisci to the tibial plateau is essential for the performance of this function, with root abnormalities being associated with meniscal extrusion and the development of degenerative joint disease14,15. Biomechanical evidence supports this association as root injury produces increased tibiofemoral contact pressures with applied loads8,16.
Insertion Site Anatomy
Several authors have recently explored the anatomy of the insertion sites of the anterior and posterior root attachments of the medial and lateral menisci17-20. The morphology of the attachment of the anterior root of the medial meniscus is variable. The anterior root may insert onto the flat portion of the intercondylar region of the tibia, onto the slope from the medial spine down toward the intercondylar area, or onto the anterior slope of the plateau, or it may be secured only with a soft-tissue attachment without osseous attachment to the plateau21. In the study by LaPrade et al.18, the anterior root of the medial meniscus covered an average area (and standard deviation) of 56.3 ± 14.9 mm2. With respect to identifiable arthroscopic landmarks, the anterior root attachment of the medial meniscus is 27.5 ± 3.3 mm anterior to the apex of the medial tibial eminence, 9.2 ± 2.7 mm anterior to the anterior edge of the anterior cruciate ligament (ACL), and 7.6 ± 2.3 mm anterolateral to the medial articular surface18,22,23. The smaller anterior root attachment of the lateral meniscus is located adjacent to the tibial insertion of the ACL23, and, as such, is often used as a reference point for the tibial insertion of the ACL during ACL reconstruction. The anterior root of the lateral meniscus is often confluent with the ACL, with an average of 88.9 mm2 of overlap shared between the insertion sites18,23-25. The anterior root of the lateral meniscus covers 140.7 mm2 and is 14.2 ± 2.2 mm anteromedial to the apex of the lateral tibial eminence, 5.0 ± 1.8 mm anterolateral to the center of the ACL, and 13.4 ± 2.1 mm anterior to the nearest edge of the posterior lateral meniscal root18,25.
The posterior root of the medial meniscus inserts 9.6 mm posterior and 0.7 mm lateral to the apex of the medial tibial eminence, in a position 3.5 mm lateral to the inflection point of the medial plateau articular cartilage and 8.2 mm anterior to the posterior cruciate ligament (PCL)20. In addition to this direct insertion, supplemental, diagonally oriented fibers have been described on the posterior aspect of the posterior root of the medial meniscus26. These fibers are referred to as “shiny white fibers” because of their arthroscopic appearance20. The posterior root of the lateral meniscus inserts more anteriorly than its medial counterpart. The insertion of the posterior root of the lateral meniscus lies 4.2 mm medial and 1.5 mm posterior to the apex of the lateral tibial eminence, at a point 4.3 mm medial to the articular margin of the lateral plateau and 12.7 mm anterior to the PCL20 (Fig. 1).
Magnetic resonance imaging (MRI) studies have supplemented the anatomical data obtained from cadaveric dissections27,28. In addition to permitting an in vivo assessment of root morphology and dimensions, characteristic MRI signals have been identified for each root in the uninjured state. The anterior root of the medial meniscus is most often low signal on proton-density-weighted (PDW) MRI scans. The posterior root of the medial meniscus and the anterior root of the lateral meniscus appear either hyperintense or with alternating striations of hyperintensity and hypointensity. The posterior root of the lateral meniscus is either hypointense or striated27.
Biomechanical Consequences of Meniscal Root Injury
Prior to consideration of the effect of meniscal root pathology on tibiofemoral biomechanics, it should be noted that meniscal root injury may not occur in isolation and may be the result of a preexisting biomechanical abnormality in a previously asymptomatic knee. Concomitant ligament injury has implications for knee stability; in a cadaveric model, lateral meniscal root injury was found to further reduce the stability of the ACL-deficient knee in rotational loading29. Similarly, anterior or posterior root tears of the medial meniscus confer decreased translational and rotational stability of the knee in both ACL-intact and ACL-deficient states11,30,31. Lower-extremity alignment abnormalities may predispose patients to root injury; in a retrospective case-control study comparing 27 posterior medial meniscal root tears with 19 posterior medial horn cleavage tears, preoperative standing lower-extremity alignment radiographs demonstrated significantly increased mean tibiofemoral varus alignment in patients with root tears (p = 0.002)32.
Even without concomitant abnormalities, meniscal root tears have a profound effect on the biomechanics of the knee5,6,8,15,16,33,34. In a cadaveric study analyzing loading and kinematics in intact knees, knees with a posterior root tear of the medial meniscus, knees with a repaired posterior root, and knees with a total meniscectomy, Allaire et al. found that a root tear resulted in increased tibiofemoral contact pressure equal to that following a total meniscectomy, whereas repair restored contact pressure to that of the uninjured knee5. Marzo and Gurske-DePerio confirmed these findings in a cadaveric study of contact pressure in intact, posteromedial root-injured, and root-repaired cadaveric knees34. Forkel et al. confirmed the findings of increased contact pressure in association with meniscal root injuries on the medial side but demonstrated that tibiofemoral contact pressure was not significantly increased in association with lateral root injury (p > 0.05) unless the meniscofemoral ligament was sectioned, concluding that an isolated lateral root injury without damage to the meniscofemoral ligament might have a better prognosis than its medial counterpart6. Although these in vitro findings suggest a prognostic role for the integrity of the meniscofemoral ligament, the lack of corresponding clinical data and the difficulty of visualizing this structure arthroscopically currently limit its use in clinical decision-making. While we are aware of no long-term studies that prove the role of meniscal root tears in subsequent joint degeneration, a recent imaging study demonstrated that tears of the posterior root of the medial meniscus were independent risk factors for the development of cartilage degeneration as seen on T1ρ MRI scans35.
Diagnosis of Meniscal Root Tears
The clinical diagnosis of meniscal root tears may be difficult as the signs and symptoms typically associated with meniscal body injuries, such as mechanical locking and catching, may not be present in patients with root injury. In addition, there may or may not be a history of an acute traumatic event. In a recent series, 31 (68.9%) of 45 patients undergoing repair of the posterior root of the medial meniscus reported only minor trauma36. The remainder of the patients reported no trauma, and the mean time from symptom onset to repair was >4 months. These findings may indicate a degenerative element in the pathogenesis of meniscal root injury.
The most common signs of meniscal root injury are joint line tenderness and pain on deep knee flexion. One study demonstrated joint line tenderness in 45 (100%) of 45 patients who underwent root repair36. Another study demonstrated joint line tenderness in 13 (62%) of 21 patients undergoing repair of a posteromedial root tear37. The authors of those studies found pain on deep flexion in 41 (91%) of 45 patients36 and 14 (67%) of 21 patients37, respectively. Effusion was present in 36 (80%) of 45 patients in one of those studies36 and in only 3 (14%) of 21 patients in the other study37. McMurray testing was positive in 35 (78%) of 45 patients36 and 12 (57%) of 21 patients37, respectively. Locking was present in 25 (56%) of 45 patients36 and 3 (14%) of 21 patients37. Giving-way was noted in 9 (20%) of 45 patients36 and 2 (10%) of 21 patients37. These results are summarized in Table I. However, the sensitivity and specificity of signs and symptoms of meniscal root injury have not been elucidated, with most authors relying on MRI to confirm the diagnosis.
Orthogonal weight-bearing radiographs of the affected knee are made to rule out osseous abnormality and to assess for evidence of degenerative joint disease. Full-length, standing bilateral lower-extremity alignment radiographs are made for any patient with clinical examination findings that suggest the presence of malalignment. MRI is the mainstay of diagnostic imaging for meniscal root abnormality38. MRI can identify meniscal root abnormality and the extent of extrusion from the tibiofemoral joint39-41. The meniscal roots should be specifically reviewed as part of the surgeon’s MRI interpretation routine because injuries may otherwise easily be missed, with recent studies demonstrating moderate sensitivity and specificity and low positive predictive value for diagnosing root tears38,42-44.
MRI signs indicative of meniscal root abnormality include (1) a radial tear of the meniscal root on axial imaging (Fig. 2), (2) a vertical linear defect in the meniscal root on coronal imaging (truncation sign) (Fig. 3-A), (3) increased signal in the meniscal root on sagittal sequences (ghost sign) (Fig. 3-B), and (4) meniscal extrusion >3 mm outside the peripheral margin of the joint on coronal imaging (Fig. 4). Meniscal extrusion of >3 mm is strongly associated with meniscal root abnormality as well as the presence14 and severity45 of radiographic signs of degenerative joint disease.
The ability of MRI to detect meniscal root abnormality has varied among reports. Thus, high-quality images and skilled interpretation are essential. In a series of 287 consecutive patients who had a preoperative MRI evaluation followed by arthroscopic surgery, LaPrade et al.43 found that MRI had an overall sensitivity of 77% and a specificity of 73% for the detection of root tears. For medial tears, the sensitivity and specificity were 82% and 80%, respectively. For lateral tears, the sensitivity and specificity were 60% and 90%, respectively. Other authors have reported higher sensitivities and specificities ranging from 89% to 100% for medial38,41,44 and lateral42 meniscal root tears.
Indications for Operative Treatment
The treatment of meniscal root tears has evolved in recent years, and current options include nonoperative therapy, partial meniscectomy, and meniscal root repair. Ideally, meniscal root repair restores native joint biomechanics, although not all patients are candidates for surgery and not all root tears are amenable to repair. Patient selection is therefore highly important. Those who are not ideal candidates for meniscal root repair may benefit from nonoperative therapy.
The indications for nonoperative treatment of meniscal root tears include a sedentary lifestyle, extensive medical comorbidities, advanced signs of osteoarthritis (Outerbridge46 grade 3 or 4), joint-space narrowing, marked varus malalignment (>5°), or chronic, degenerative, irreparable tears47,48. An age of >45 or 50 years has been cited as a contraindication to operative treatment as degenerative meniscal tissue is assumed to have poor healing capacity; however, recent studies have demonstrated good short-term clinical results in patients >50 years of age1,47-49. Patients meeting the criteria for nonoperative treatment may benefit from a multimodal approach including physical therapy, nonsteroidal anti-inflammatory drugs, intra-articular injections, and off-loader bracing to provide symptomatic relief50.
Two surgical options—arthroscopic meniscectomy or arthroscopic meniscal root repair—are available for active, healthy individuals with minimal or no degenerative changes (Outerbridge grade 1 or 2), minimal to no joint-space narrowing, normal mechanical alignment, intact cruciate ligaments, and meniscal root tears1,12,48. Meniscectomy is potentially a better option for chronic root tears because the healing capacity and tissue quality of the meniscus are poor; however, the definition of chronicity with respect to reparability has yet to be determined49. While subjective clinical improvement has been seen following meniscectomy, outcomes may be worse in comparison with meniscal root repair, with postoperative degenerative changes becoming more pronounced1,4,7. In addition, there is some evidence to suggest that partial meniscectomy for the treatment of root tears may portend poorer outcomes compared with partial meniscectomy for the treatment of other types of meniscal abnormality, potentially suggesting that chronic root tears should be treated conservatively5,51,52. Partial meniscectomy in the setting of a root tear effectively creates a meniscus-deficient state, resulting in progressive chondral degeneration and eventual osteoarthritis5,51,52. Conversely, patients with acute tears may benefit from root repair; Kim et al. demonstrated greater improvement and decreased subsequent degenerative changes in patients who underwent root repair 4 years after surgery4. However, root repair in patients with excessive varus malalignment (>5°) and radiographic signs of chondral degeneration (Kellgren-Lawrence53 grade III or IV and Outerbridge grade III or IV) have been shown to have poorer clinical outcomes and may not be indicated for repair unless a realignment procedure is planned or the chondral lesion is focal and can be addressed with a cartilage procedure47,48. Acute tears in the setting of an ACL rupture or multiligamentous injury should also be repaired to restore native meniscal anatomy in an effort to prevent future degeneration12.
As outlined by LaPrade et al., the decision to repair a meniscal root tear can be simplified54. Patients who are not candidates for surgery should have nonoperative treatment. Surgical candidates with healthy articular surfaces, as described above, and acute meniscal root tears should undergo arthroscopic meniscal root repair. Patients with chronic meniscal root tears in the setting of little to no articular cartilage wear (Outerbridge grade 1 or 2) are candidates for meniscal root repair, whereas those with symptomatic tears demonstrating advanced degenerative changes (Outerbridge grade 3 or 4) are indicated for arthroscopic meniscectomy. Patients with excessive varus deformity should also be evaluated for possible staged or concomitant high tibial osteotomy (HTO).
Techniques for Arthroscopic Meniscal Root Repair
Two main approaches for meniscal root repair have evolved36,55. One approach involves the use of a transtibial pullout technique, and the other involves the use of a suture anchor repair. The goal of both approaches is to restore an anatomical attachment of the meniscal root to bone that is capable of converting axial weight-bearing loads into hoop stresses. With the knee in 90° of flexion, with or without a leg holder, standard anteromedial and anterolateral arthroscopic portals are created. Often, accessory posteromedial or posterolateral portals are created to facilitate anchor placement or suture passage.
Transtibial Pullout Repair (Authors’ Preferred Technique)
Under arthroscopic visualization, the anatomical position of the meniscal root is identified, debrided, and prepared for repair. An ACL tibial drill guide is utilized to drill a guide pin or a retro-cutting reamer into position through a small incision at the anteromedial aspect of the proximal aspect of the tibia. After confirmation of anatomical positioning, a 5 to 6-mm-diameter tunnel is made with use of a reamer or a 1-cm-deep tunnel is made with use of a retro-cutting reamer. The use of a traditional or retro-cutting reamer is subject to surgeon preference. Number-2 nonabsorbable sutures are passed through the substance of the torn meniscal root with a suture-passage device of the surgeon’s choosing. Once passed, the suture limbs are shuttled through the transtibial tunnel, tensioned, and fixed with use of whatever fixation construct the surgeon prefers (typically a cortical button or screw and washer) with the knee in 30° of flexion56. This degree of knee flexion facilitates fixation of the root while the meniscus is in an anatomical, reduced position (Video 1).
Suture Anchor Repair
Suture anchor repair utilizes the accessory posteromedial or posterolateral portal to facilitate anchor insertion at the anatomical root-attachment site and suture passage through the torn meniscal root. Often, the accessory portal is created more proximally than usual to allow for more vertical insertion of the suture anchor and avoidance of the posterior convexity of the medial femoral condyle36,54,55. Under arthroscopic visualization, the anatomical position of the meniscal root is identified, debrided, and prepared for repair. A double-loaded suture anchor is inserted at the meniscal root site and suture passage is performed with use of a suture lasso through the accessory portal or with use of a rotator cuff-type suture-passage device through the anteromedial or anterolateral portal. Once passed, the suture limbs are tied arthroscopically with the knee in 30° of flexion, with the arthroscopic knots being kept posterior, away from the articular surfaces of the affected compartment36,55.
Suture Configurations for Meniscal Root Repair
Various suture configurations have been reported for use in meniscal root repairs, including 2 simple sutures, horizontal mattress sutures, modified Mason-Allen sutures, and different loop/cinch stitch approaches. Anz et al. evaluated 4 different suture configurations, including 2 simple sutures, an inverted mattress suture, 1 double-locking loop suture, and 2 double-locking loop sutures, in a cadaveric model57. The authors found that the 2 double-locking loop sutures had significantly higher failure loads compared with the other 3 methods tested (p < 0.01). In a biomechanical study, Feucht et al. demonstrated that the modified Mason-Allen and 2-simple-suture approaches outperformed horizontal mattress and loop stitch configurations with respect to stiffness, cyclic loading, and load-to-failure testing58. Lee et al. compared the clinical and radiographic results for 25 patients who underwent arthroscopic medial meniscal root repair with use of a Mason-Allen stitch configuration with those for 25 patients in whom the repair was performed with simple stitches59. Although no significant differences in clinical outcomes were noted at the time of short-term follow-up, patients who had been managed with a Mason-Allen-type repair had less meniscal extrusion and less cartilage degeneration on follow-up MRI scans.
Potential complications associated with meniscal root repair include the potential for neurovascular injury related to poorly visualized guide-pin placement, iatrogenic injury to the ACL or PCL, failure of the meniscal root to heal, and other general complications of knee arthroscopy, including infection, postoperative stiffness, and deep venous thrombosis56.
There is considerable variability in published postoperative protocols after meniscal root repair. Most protocols involve early immobilization and protected weight-bearing, allowance of gradually increased flexion, and return to sport at 6 months. Isometric quadriceps activation is permitted early. If ACL reconstruction is performed concomitantly, rehabilitation includes a standardized ACL protocol, with modifications to weight-bearing allowance (non-weight-bearing for 6 weeks) and restriction of deep flexion (no flexion past 90° for 4 weeks) to protect the meniscal root repair. We do not recommend staging meniscal root repair and ACL surgery as both can be performed in a single surgical setting.
Many authors recommend 2 weeks of immobilization in full extension with use of either a cylinder cast36,37,48,60 or a hinged brace locked in extension61. At 2 weeks postoperatively, either external immobilization is discarded or the patient is transitioned from a cast to a hinged knee brace36,37,60. Other authors have advocated early range of motion4,59. Following meniscal root repair, we recommend the use of a hinged knee brace locked in extension for 2 weeks. The brace is then unlocked to facilitate return of range of motion.
Some restriction of weight-bearing is widely recommended in the first 6 weeks. Protocols include partial weight-bearing for 6 weeks4, toe-touch weight-bearing for 6 weeks48,59, non-weight-bearing for 6 weeks12,60, and non-weight-bearing for 6 weeks followed by partial weight-bearing for an additional 2 weeks36,37. Following meniscal root repair, we recommend 6 weeks of non-weight-bearing with use of crutches as assistive devices.
Range of Motion, Deep Flexion, and Return to Sport
Range of motion is gradually increased during the postoperative period. Most authors have reported that they allow active flexion up to 90° starting at 2, 4, or 6 weeks postoperatively36,37,48,60. Deep flexion and squatting are generally prohibited for 3 to 6 months, and return to sport is permitted at 6 months12,36,37,48,59-61. Following meniscal root repair, we recommend a hinged knee brace locked in extension for 2 weeks. The brace is then unlocked to facilitate return of range of motion and is set from 0° to 90° until 4 weeks postoperatively, at which time it is completely unlocked. The brace is removed at 6 weeks postoperatively. Depending on the return of strength and endurance of the quadriceps and the resolution of pain and swelling at the operative site, return to athletic activity is permitted at 6 months postoperatively.
Outcomes of Surgical Repair
In the last 7 years, a number of clinical studies evaluating the outcomes following meniscal root repair have been published in the orthopaedic surgery literature (Table II)1,4,36,37,47,48,59-61. To date, all reported studies have been Level-III and IV evidence, including 5 retrospective comparative studies and 4 case series. Each published study demonstrated improvements in clinical outcome scores compared with the preoperative baseline values. Ahn et al. reported significantly better results compared with conservative management (p < 0.001)47. Two studies demonstrated significantly (p < 0.05) better outcomes following meniscal root repair compared with partial meniscectomy1,4, with Chung et al. reporting a 35% rate of conversion to total knee arthroplasty in the meniscectomy group compared with 0% in the repair group1. Two small case series that included data from second-look arthroscopies demonstrated a variable rate of healing following meniscal root repair60,61. Cho and Song, in a series of 13 patients, reported that, at the time of second-look arthroscopy, 4 repairs were completely healed, 4 had healed in a lax position, 4 had healed with scar tissue, and 1 had failed to heal60. Seo et al. reported similar variability of root healing in their series of 11 cases, with 5 repairs healing in a lax position, 4 healing with scar tissue, and 2 failing to heal61. Most studies in the literature have reported the percentage of patients in whom progression of osteoarthritis is evident on follow-up imaging. While meniscal root repair demonstrates the ability to slow the progression of arthritic changes compared with meniscectomy, the procedure does not completely prevent the development of future degenerative disease.
In the recent systematic review by Feucht et al., the compiled data revealed a predominantly female population (83%) with a mean age of 55.3 years; demonstrated no progression of cartilage degeneration in 84% and 82% of patients who were evaluated with conventional radiographs and MRI, respectively; and demonstrated decreased meniscal extrusion in 56% of patients62. Healing, assessed with a combination of MRI and second-look arthroscopy, was reported as complete in 62% of patients, partial in 34%, and failed in 3%. All studies demonstrated improvements in subjective and functional scores at a mean of 30.2 months, with the mean Lysholm score increasing from 52.4 preoperatively to 85.9 postoperatively.
Lee et al. reported a 5% rate of reoperation, most commonly performed because of recurrent symptoms related to a complete or partial retear of the meniscal root37. Chung et al., in a study of fifty-seven patients with posterior meniscal root tears, reported that the 5-year survival rate was 100% after meniscal repair, compared 75% after meniscectomy1.
While long-term data on meniscal root repair are scarce, Kenny, in 2009, reported the case of a patient who was followed for 20 years after transtibial pull-out fixation of a lateral posterior meniscal root avulsion63. Second-look arthroscopy revealed improvement of prior chondromalacia and a healed posterior root. Objective and subjective functional outcome was excellent, and radiographic assessment revealed only mild degenerative changes. While the majority of meniscal root tears are medial, the success of the repair of this lateral meniscal root tear suggests a role for the procedure in effectively restoring native meniscal function and biomechanical properties as a joint-preserving procedure.
Recommendations for Care
With an improved understanding of the important role that an intact meniscal root has on proper meniscal function, the recent attention paid to the identification and treatment of meniscal root tears is appropriate and necessary. While the biomechanical data are relatively consistent in demonstrating the negative implications of meniscal root tears on tibiofemoral contact pressures and the ability of root repairs to restore normal meniscal function, the current clinical outcome data are limited in terms of study size and duration of follow-up. The majority of the available outcome studies represent Level-III and IV evidence, with no randomized controlled trials currently available in the literature comparing the outcomes following meniscectomy with those following meniscal root repair or comparing transtibial with suture anchor repair techniques. What is supported by the existing literature is that healed meniscal root repairs restore meniscal continuity, thereby restoring meniscal integrity and the ability of the meniscus to generate hoop stress as a means of resisting axial load, leading to improvements in terms of symptoms and function. While additional data are necessary to determine the role of root repair in joint preservation and which repair technique is optimal, on the basis of the currently available literature, a Grade-B recommendation (one supported by fair evidence [consistent findings in Level-II and III studies]) is appropriate for the repair of meniscal root tears (Table III).
Investigation performed at the Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY
Disclosure: No external sources of funding were utilized in the preparation of this manuscript. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article.
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