What Is Meniscal Root Repair?
A root tear detaches the meniscus from its bony insertion, causing the entire structure to fail like a total meniscectomy. Root repair uses arthroscopic tunnels and high-strength sutures to reattach the meniscus, restoring hoop stresses and preventing rapid joint degeneration.
Root Tear Patterns
- Posterior medial root tears: Common in middle-aged patients with degenerative changes.
- Posterior lateral root tears: Frequently associated with ACL injuries or trauma.
- Complex avulsions: Include radial components requiring combined repair techniques.
- Chronic tears with extrusion: May need additional centralisation sutures to reposition the meniscus.
Who Should Consider Root Repair?
Early diagnosis is critical. Root repair is recommended for patients who want to preserve cartilage and avoid early arthritis.
- Acute avulsions: Sudden posterior knee pain after squatting, twisting, or heavy lifting.
- Meniscus extrusion on MRI: Root disruption causing the meniscus to shift outward.
- Young or middle-aged patients: Those with good cartilage who wish to avoid joint replacement.
- ACL-associated tears: Root repair performed simultaneously with ligament reconstruction.
Standing radiographs, MRI, and sometimes CT arthrograms confirm root tears and evaluate cartilage status.
How Root Repair Works
Precise tunnel placement and strong fixation are essential to mimic native anatomy.
- Arthroscopic evaluation: Confirms tear type and prepares the footprint by removing scar tissue.
- Suture placement: High-strength sutures capture the meniscal horn via all-inside or outside-in techniques.
- Transtibial tunnel drilling: A tunnel is created from the tibial cortex to the root footprint.
- Button fixation: Sutures exit through the tunnel and are tied over a button or screw, compressing the meniscus to bone.
Benefits of Root Repair
- Restores load sharing: Reattached meniscus distributes forces evenly across cartilage.
- Slows arthritis: Preserving the root protects the joint from rapid degeneration.
- Improves function: Reduces pain with squatting, stair climbing, and long walks.
- Supports active lifestyles: Athletes can return to sport once healing is confirmed.
Rehab Guidelines
- Weeks 0–4: Non-weight-bearing with brace locked in extension; focus on quad activation.
- Weeks 5–8: Partial weight-bearing, gradual flexion to 90°, and stationary cycling.
- Months 3–4: Full weight-bearing, closed-chain strengthening, and pool therapy.
- Months 5–6: Jogging, agility drills, and sport-specific conditioning.
- Long-term: Maintenance exercises protect the repair and overall knee health.
Risks & Considerations
Root repair has excellent success rates; still, informed consent matters.
- Failure to heal: Scar tissue or poor bone quality may limit healing; we optimise vitamin D and metabolic factors.
- Re-tear: Avoid deep squats and impact until the repair fully integrates.
- Stiffness: Controlled motion protocols prevent arthrofibrosis.
- Deep vein thrombosis: Prevented with mobilisation, hydration, and medication when indicated.
- Need for alignment correction: Varus knees may require high tibial osteotomy to protect the repair.
We monitor healing with clinical exams and follow-up MRI or ultrasound when necessary, ensuring long-term success.