Root tears of the medial meniscus are being recognized on an MRI with increasing frequency. Most of you who have a root tear do not recall an injury to your knee. That is a degenerative meniscus root tear. A handful of you had a significant sports-related injury or ACL tear and find that you also have a root tear. How we treat these meniscus root tears will depend a lot on your age, how your tear occurred, the location of your root tear, and whether or not anything else is injured.
A root tear of the medial meniscus is a unique tear. Repairing a root tear of the medial meniscus requires a very different approach than a traditional meniscal repair. Root tears that occur after trauma and an ACL tear will require a meniscus root repair. This is in contrast to the more common degenerative root tear. Some degenerative root tears will benefit from a repair, and some may not. We can help guide you through that decision making. This article will discuss what root tears of the meniscus are and the thought process behind how we treat them.
The meniscus is a c-shaped cartilage cushion in the knee joint. It functions as a shock absorber and a stabilizer. Tears of the meniscus are prevalent. Root tears are not very common, but they are increasingly being recognized as a cause of severe arthritis. Your doctor must be well versed in root tears since they behave much differently than a typical meniscus tear.
What is the “Root” of the Meniscus?
The meniscus is attached or anchored to the tibia by two “roots.” There is a root attachment in the front of the meniscus and a root attachment in the back (posterior) of the meniscus. In most injuries, it is the posterior root attachment that is torn. Problems arise with root tears because if the root of the meniscus is torn, then the entire meniscus becomes non-functional. In other words, the meniscus needs to be well anchored to the tibia to function as a shock absorber.
How Did I Tear The Root of the Meniscus?
Many meniscus root tears occur as a result of trauma. Some root tears occur at the same time you tore your ACL. Other common causes of root tears might be a fall, slip on ice, or related to a sports injury. As we age, it is easier to tear the root of the meniscus, especially the medial meniscus root. Therefore you may tear the root by merely kneeling or squatting down. The average age of patients with root tears in my practice is between 25 and 65. The younger patients tend to have lateral root tears in association with ACL tears. The older patients tend to have medial root tears in association with early arthritic changes. Root tears that occur in association or with coexisting osteoarthritis are the most common form of root tear seen by orthopedic surgeons. Most of you will note that you knelt, bent your knee or twisted, felt a pop, and then noted increasingly more severe pain in the knee.
Patients with root tears of the medial meniscus often complain of giving way or instability. They are fearful that the knee will buckle or give-out. The onset of pain is often abrupt, and the pain is usually on the inner side of the knee, or in the back of the knee.
How Do You Fix A Root Tear of the meniscus?
To fix the root of the meniscus, we need to pull the root against the tibia in the same place where the root was before your injury. The procedure is mostly arthroscopic. It is a technically challenging procedure, so please be sure that your physician has performed many of these. After we put a suture around the root of the meniscus, we drill a hole from the front of your tibia into the root area. We then bring the stitches out through the hole and tie them over the front of the tibia. Therefore we are pulling the root down into the tibia, and the stitching will hold it in place until it heals. In the picture above, you can see how the stitch is through the root of the meniscus, and the meniscus is being pulled down into a small hole I created to encourage healing.
Do All Meniscus Root Tears Need Surgery?
The body of evidence about the treatment of root tears of the meniscus is growing. There is a generalized agreement that most medial root tears that occur in the setting of moderate or severe osteoarthritis should not be fixed. In these cases, the meniscus is usually degenerative or wearing out. Studies have shown that if these tears are fixed, they will commonly tear again in a very short time frame. If the arthritis is severe, then fixing the root tear may not alleviate your pain.
Root tears that occur in a severely arthritic knee should be treated with relative rest. Some of you may require a walker or crutches for limited weight-bearing. Many will benefit from the use of a compression sleeve, and after a month, a course of physical therapy.
Medial root tears with minimal osteoarthritis should likely be fixed or repaired. A successful repair will eliminate the sense of the knee giving way or feeling unstable. More importantly, fixing a medial meniscus root tear might slow the progression of osteoarthritis. But the critical issue here is that the severity of arthritis in the knee should be mild/moderate.
Root tears and ACL tears often occur together
Meniscus root tears often occur when you tear your ACL. If you have a traumatic root tear due to a severe injury, there is agreement amongst sports surgeons and orthopedic surgeons that these tears should be repaired at the same time that the ligament is reconstructed.
Do root repairs heal well?
Some studies show that a high percentage of these root repairs are successful, and there are studies that show that the success rate might be far lower. Many factors will often determine the success rate. First is whether or not you have anything else wrong with your joint… such as osteoarthritis. Other reasons for failure include lack of biological healing, resuming activities too quickly leading to a new tear, and over-tightening the repair, which could lead to a new tear somewhere else.
If you have a root tear as a result of a traumatic injury, be sure you see a Sports Medicine Trained Orthopedic Surgeon with experience repairing meniscus root tears. Some tears might be considered for repair, and others may not. IF you have osteoarthritis, and it is moderately severe, then having surgery for your root tear might not be advisable.
Hopefully, this has improved your understanding of meniscus root tears of the medial meniscus. Here is a review of root tears that might be worth reviewing.