Meniscal root tears defined as bony or soft tissue root avulsion injuries or radial tears within 1cm of the meniscal root attachment. If it is not treated properly can cause early development of osteoarthritis. The meniscal root tears leading to compromised hoop stress and decreased tibiofemoral contact area and increased contact pressures in the involved compartment. To confirm the diagnosis is through arthroscopic as a diagnostic and treatment and through magnetic resonance imaging. Not all meniscal root tears can be treated surgically, especially if they have multiple comorbidities or advanced age, severe osteoarthritis, non-symptomatic chronic meniscal root tears and significant mal-alignment of the affected compartment then the treatment of choice is to give a symptomatic treatment like non-steroid anti-inflammatory drug, and activity modification. Meniscectomy has been found to induce a high rate of arthritis progression postoperatively. There are two most common meniscal root repair techniques which are trans-tibial pullout repair and suture anchor repair that now preferred over meniscectomy. The most important thing to consider when repairing the meniscal root is the right anatomically repair. It has been proven that non-anatomical meniscal root repair will not able to restore to the normal function because the conversion of femorotibial loads into circumferential tension may be altered, with functional impairment of the knee. Anchor suture technique shows a greater degree of healing and better biomechanical outcome. The suture anchor technique uses “all-inside" fixation and avoids the need for a distal fixation which potentially places abrasive forces on the sutures used. The trans-tibial pullout repair can restore the attachment and contact pressure near normal value, also the tunnel drilling stimulating growth factors and progenitor cells from bone marrow and facilitate the ability of meniscus to convert axial load into hoop stress. The concern of trans-tibial pullout repair is its ‘bungee effect’ and repetitive loading resulted in the displacement of this repair complex and might compromise healing because of decreased stiffness and micromotion of the meniscus-suture complex.
Biomechanical comparison of four tibial fixation techniques for meniscal root sutures in posterior medial meniscus root repair: A porcine study
