The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Meniscal Root Tears: A Decade of Research on their Relevant Anatomy, Biomechanics, Diagnosis, and Treatment

Document Type : CURRENT CONCEPTS REVIEW

Authors
Mark T. Banovetz 1
Lindsay C. Roethke 1
Ariel N. Rodriguez 2
Robert F. LaPrade 3
1 1 Twin Cities Orthopedics, Edina-Crosstown, Edina, MN, USA 2 University of Minnesota Medical School, Minneapolis, MN, USA
2 1 Twin Cities Orthopedics, Edina-Crosstown, Edina, MN, USA 3 Georgetown University School of Medicine, Washington, DC, USA
3 Twin Cities Orthopedics, Edina-Crosstown, Edina, MN, USA
10.22038/abjs.2021.60054.2958
Abstract
CURRENT CONCEPTS REVIEW: MENISCAL ROOT TEARS
Keywords
Anterior cruciate ligament
Meniscus
Root
  1. LaPrade RF, Floyd ER, Carlson GB, Moatshe G, Chahla J, Monson JK. Meniscal root tears: Solving the silent epidemic. Journal of Arthroscopic Surgery and Sports Medicine. 2021;2(1):47-57.
  2. LaPrade CM, Jansson KS, Dornan G, Smith SD, Wijdicks CA, LaPrade RF. Altered tibiofemoral contact mechanics due to lateral meniscus posterior horn root avulsions and radial tears can be restored with in situ pull-out suture repairs. J Bone Joint Surg Am. 2014;96(6):471-9.
  3. Steineman BD, LaPrade RF, Santangelo KS, Warner BT, Goodrich LR, Haut Donahue TL. Early Osteoarthritis After Untreated Anterior Meniscal Root Tears: An In Vivo Animal Study. Orthop J Sports Med. 2017;5(4):2325967117702452.
  4. Cinque ME, DePhillipo NN, Moatshe G, Chahla J, Kennedy MI, Dornan GJ, et al. Clinical Outcomes of Inside-Out Meniscal Repair According to Anatomic Zone of the Meniscal Tear. Orthop J Sports Med. 2019;7(7):2325967119860806.
  5. Matheny LM, Ockuly AC, Steadman JR, LaPrade RF. Posterior meniscus root tears: associated pathologies to assist as diagnostic tools. Knee Surg Sports Traumatol Arthrosc. 2015;23(10):3127-31.
  6. LaPrade CM, Foad A, Smith SD, Turnbull TL, Dornan GJ, Engebretsen L, et al. Biomechanical consequences of a nonanatomic posterior medial meniscal root repair. Am J Sports Med. 2015;43(4):912-20.
  7. LaPrade CM, James EW, Cram TR, Feagin JA, Engebretsen L, LaPrade RF. Meniscal root tears: a classification system based on tear morphology. Am J Sports Med. 2015;43(2):363-9.
  8. Dean RS, DePhillipo NN, Monson JK, LaPrade RF. Peripheral Stabilization Suture to Address Meniscal Extrusion in a Revision Meniscal Root Repair: Surgical Technique and Rehabilitation Protocol. Arthrosc Tech. 2020;9(8):e1211-e8.
  9. Johannsen AM, Civitarese DM, Padalecki JR, Goldsmith MT, Wijdicks CA, LaPrade RF. Qualitative and quantitative anatomic analysis of the posterior root attachments of the medial and lateral menisci. Am J Sports Med. 2012;40(10):2342-7.
  10. Kennedy NI, Michalski MP, Engebretsen L, LaPrade RF. Iatrogenic Meniscus Posterior Root Injury Following Reconstruction of the Posterior Cruciate Ligament: A Report of Three Cases. JBJS Case Connect. 2014;4(1 Suppl 6):e20-e6.
  11. Griffith CJ, LaPrade RF, Fritts HM, Morgan PM. Posterior root avulsion fracture of the medial meniscus in an adolescent female patient with surgical reattachment. Am J Sports Med. 2008;36(4):789-92.
  12. Mueller BT, Moulton SG, O’Brien L, LaPrade RF. Rehabilitation following meniscal root repair: A clinical commentary. journal of orthopaedic & sports physical therapy. 2016;46(2):104-13.
  13. LaPrade RF, LaPrade CM, James EW. Recent advances in posterior meniscal root repair techniques. J Am Acad Orthop Surg. 2015;23(2):71-6.
  14. Hussain ZB, Chahla J, Mandelbaum BR, Gomoll AH, LaPrade RF. The Role of Meniscal Tears in Spontaneous Osteonecrosis of the Knee: A Systematic Review of Suspected Etiology and a Call to Revisit Nomenclature. Am J Sports Med. 2019;47(2):501-7.
  15. Marzo JM. Medial meniscus posterior horn avulsion. J Am Acad Orthop Surg. 2009;17(5):276-83.
  16. LaPrade CM, LaPrade MD, Turnbull TL, Wijdicks CA, LaPrade RF. Biomechanical evaluation of the transtibial pull-out technique for posterior medial meniscal root repairs using 1 and 2 transtibial bone tunnels. Am J Sports Med. 2015;43(4):899-904.
  17. Padalecki JR, Jansson KS, Smith SD, Dornan GJ, Pierce CM, Wijdicks CA, et al. Biomechanical consequences of a complete radial tear adjacent to the medial meniscus posterior root attachment site: in situ pull-out repair restores derangement of joint mechanics. Am J Sports Med. 2014;42(3):699-707.
  18. Lerer DB, Umans HR, Hu MX, Jones MH. The role of meniscal root pathology and radial meniscal tear in medial meniscal extrusion. Skeletal Radiol. 2004;33(10):569-74.
  19. Allaire R, Muriuki M, Gilbertson L, Harner CD. Biomechanical consequences of a tear of the posterior root of the medial meniscus. Similar to total meniscectomy. J Bone Joint Surg Am. 2008;90(9):1922-31.
  20. LaPrade RF, Padalecki JR, Jansson K, Smith S, Dornan G, Pierce C, et al. Biomechanical Consequences of a Complete Radial Tear Adjacent to the Medial Meniscus Posterior Root Attachment Site. Orthop J Sports Med. 2014;2(3_suppl).
  21. LaPrade CM, Ellman MB, Rasmussen MT, James EW, Wijdicks CA, Engebretsen L, et al. Anatomy of the anterior root attachments of the medial and lateral menisci: a quantitative analysis. Am J Sports Med. 2014;42(10):2386-92.
  22. Ellman MB, LaPrade CM, Smith SD, Rasmussen MT, Engebretsen L, Wijdicks CA, et al. Structural Properties of the Meniscal Roots. Am J Sports Med. 2014;42(8):1881-7.
  23. Nelson EW, LaPrade, R.F. The Anterior Intermeniscal Ligament of the Knee: An Anatomic Study. The American Journal of Sports Medicine. 2000;28(1):74-6.
  24. LaPrade RF, DePhillipo NN, Larson CM. Editorial Commentary: Comparing Medial and Lateral Meniscal Root Tears Is Like Comparing Apples and Oranges. Arthroscopy. 2020;36(4):1142-4.
  25. Steineman BD, Moulton SG, Haut Donahue TL, Fontbote CA, LaPrade CM, Cram TR, et al. Overlap Between Anterior Cruciate Ligament and Anterolateral Meniscal Root Insertions: A Scanning Electron Microscopy Study. Am J Sports Med. 2017;45(2):362-8.
  26. Oshima T, Grasso S, Beach A, Fritsch B, Parker DA. Lateral location of the tibial tunnel increases lateral meniscal extrusion after anatomical single-bundle anterior cruciate ligament reconstruction. Journal of ISAKOS. 2019;4(6):285-9.
  27. Ellman MB, James EW, LaPrade CM, LaPrade RF. Anterior meniscus root avulsion following intramedullary nailing for a tibial shaft fracture. Knee Surgery, Sports Traumatology, Arthroscopy. 2015;23(4):1188-91.
  28. Mow VC, Arnoczky SP, Jackson DW. Knee meniscus: basic and clinical foundations: Raven Press New York; 1992.
  29. Papalia R, Vasta S, Franceschi F, D’Adamio S, Maffulli N, Denaro V. Meniscal root tears: from basic science to ultimate surgery. Br Med Bull. 2013;106:91-115.
  30. Aspden RM, Yarker YE, Hukins D. Collagen orientations in the meniscus of the knee joint. Journal of anatomy. 1985;140(Pt 3):371.
  31. Petersen W, Tillmann B. Collagenous fibril texture of the human knee joint menisci. Anatomy and Embryology. 1998;197(4):317-24.
  32. Fox AJ, Bedi A, Rodeo SA. The basic science of human knee menisci: structure, composition, and function. Sports Health. 2012;4(4):340-51.
  33. James EWJ, A.M.; Cinque, M.E.; Chahla, J.; LaPrade, R.F. An evidence-based approach to the diagnosis and treatment of meniscal root tears. Minerva Ortop Traumatol. 2017;68(2):81-90.
  34. Costa CR, Morrison WB, Carrino JA. Medial meniscus extrusion on knee MRI: is extent associated with severity of degeneration or type of tear? AJR Am J Roentgenol. 2004;183(1):17-23.
  35. Floyd ER, Carlson GB, LaPrade RF. Arthroscopic-Assisted Lateral Meniscal Allograft Transplantation With Open Ligamentous Extra-Articular Tenodesis. Arthrosc Tech. 2021;10(3):e903-e8.
  36. Geeslin AG, Civitarese D, Turnbull TL, Dornan GJ, Fuso FA, LaPrade RF. Influence of lateral meniscal posterior root avulsions and the meniscofemoral ligaments on tibiofemoral contact mechanics. Knee Surg Sports Traumatol Arthrosc. 2016;24(5):1469-77.
  37. LaPrade RF, Matheny LM, Moulton SG, James EW, Dean CS. Posterior Meniscal Root Repairs: Outcomes of an Anatomic Transtibial Pull-Out Technique. Am J Sports Med. 2017;45(4):884-91.
  38. James EW, Johannsen, A.M., Cinque, M.E., Chahla, J., LaPrade, R.F. An evidence-based approach to the diagnosis and treatment of meniscal root tears. Minerva Ortopedica e Traumatologica. 2017;68(2):81-90.
  39. Stärke C, Kopf S, Gröbel K-H, Becker R. The Effect of a Nonanatomic Repair of the Meniscal Horn Attachment on Meniscal Tension: A Biomechanical Study. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2010;26(3):358-65.
  40. Shoemaker SC, Markolf KL. The role of the meniscus in the anterior-posterior stability of the loaded anterior cruciate-deficient knee. Effects of partial versus total excision. J Bone Joint Surg Am. 1986;68(1):71-9.
  41. Musahl V, Citak M, O’Loughlin PF, Choi D, Bedi A, Pearle AD. The effect of medial versus lateral meniscectomy on the stability of the anterior cruciate ligament-deficient knee. Am J Sports Med. 2010;38(8):1591-7.
  42. DePhillipo NN, Dekker TJ, Aman ZS, Bernholt D, Grantham WJ, LaPrade RF. Incidence and Healing Rates of Meniscal Tears in Patients Undergoing Repair During the First Stage of 2-Stage Revision Anterior Cruciate Ligament Reconstruction. Am J Sports Med. 2019;47(14):3389-95.
  43. Parkinson B, Robb C, Thomas M, Thompson P, Spalding T. Factors That Predict Failure in Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction. Am J Sports Med. 2017;45(7):1529-36.
  44. Logan CA, Aman ZS, Kemler BR, Storaci HW, Dornan GJ, LaPrade RF. Influence of Medial Meniscus Bucket-Handle Repair in Setting of Anterior Cruciate Ligament Reconstruction on Tibiofemoral Contact Mechanics: A Biomechanical Study. Arthroscopy. 2019;35(8):2412-20.
  45. Steineman BD, LaPrade RF, Haut Donahue TL. Nonanatomic Placement of Posteromedial Meniscal Root Repairs: A Finite Element Study. J Biomech Eng. 2020;142(8).
  46. DePhillipo NN, Kennedy MI, Chahla J, LaPrade RF. Type II Medial Meniscus Root Repair With Peripheral Release for Addressing Meniscal Extrusion. Arthrosc Tech. 2019;8(9):e941-e6.
  47. Krych AJ, Bernard CD, Kennedy NI, Tagliero AJ, Camp CL, Levy BA, et al. Medial Versus Lateral Meniscus Root Tears: Is There a Difference in Injury Presentation, Treatment Decisions, and Surgical Repair Outcomes? Arthroscopy. 2020;36(4):1135-41.
  48. LaPrade RF, LaPrade CM, Ellman MB, Turnbull TL, Cerminara AJ, Wijdicks CA. Cyclic displacement after meniscal root repair fixation: a human biomechanical evaluation. Am J Sports Med. 2015;43(4):892-8.
  49. LaPrade RF, Ho CP, James E, Crespo B, LaPrade CM, Matheny LM. Diagnostic accuracy of 3.0 T magnetic resonance imaging for the detection of meniscus posterior root pathology. Knee Surg Sports Traumatol Arthrosc. 2015;23(1):152-7.
  50. Brody JM, Hulstyn MJ, Fleming BC, Tung GA. The meniscal roots: gross anatomic correlation with 3-T MRI findings. AJR Am J Roentgenol. 2007;188(5):W446-50.
  51. Choi SH, Bae S, Ji SK, Chang MJ. The MRI findings of meniscal root tear of the medial meniscus: emphasis on coronal, sagittal and axial images. Knee Surg Sports Traumatol Arthrosc. 2012;20(10):2098-103.
  52. Magee T. MR findings of meniscal extrusion correlated with arthroscopy. J Magn Reson Imaging. 2008;28(2):466-70.
  53. DePhillipo NN, Kennedy MI, Chahla J, LaPrade RF. Type II Medial Meniscus Root Repair With Peripheral Release for Addressing Meniscal Extrusion. Arthrosc Tech. 2019;8(9):e941-e6.
  54. Dean RS, DePhillipo NN, Monson JK, LaPrade RF. Peripheral Stabilization Suture to Address Meniscal Extrusion in a Revision Meniscal Root Repair: Surgical Technique and Rehabilitation Protocol. Arthrosc Tech. 2020;9(8):e1211-e8.
  55. Lim HC, Bae JH, Wang JH, Seok CW, Kim MK. Non-operative treatment of degenerative posterior root tear of the medial meniscus. Knee Surg Sports Traumatol Arthrosc. 2010;18(4):535-9.
  56. Jung YH, Choi NH, Oh JS, Victoroff BN. All-inside repair for a root tear of the medial meniscus using a suture anchor. Am J Sports Med. 2012;40(6):1406-11.
  57. Hapa O, Aksahin E, Erduran M, Davul S, Havitcioglu H, LaPrade RF, et al. The influence of suture material on the strength of horizontal mattress suture configuration for meniscus repair. Knee. 2013;20(6):577-80.
  58. Herrlin S, Hållander M, Wange P, Weidenhielm L, Werner S. Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomised trial. Knee Surg Sports Traumatol Arthrosc. 2007;15(4):393-401.
  59. Furumatsu T, Kodama Y, Kamatsuki Y, Hino T, Okazaki Y, Ozaki T. Meniscal Extrusion Progresses Shortly after the Medial Meniscus Posterior Root Tear. Knee Surg Relat Res. 2017;29(4):295-301.
  60. Kaplan DJ, Alaia EF, Dold AP, Meislin RJ, Strauss EJ, Jazrawi LM, et al. Increased extrusion and ICRS grades at 2-year follow-up following transtibial medial meniscal root repair evaluated by MRI. Knee Surg Sports Traumatol Arthrosc. 2018;26(9):2826-34.
  61. Moon HK, Koh YG, Kim YC, Park YS, Jo SB, Kwon SK. Prognostic factors of arthroscopic pull-out repair for a posterior root tear of the medial meniscus. Am J Sports Med. 2012;40(5):1138-43.
  62. Daney BT, Aman ZS, Krob JJ, Storaci HW, Brady AW, Nakama G, et al. Utilization of Transtibial Centralization Suture Best Minimizes Extrusion and Restores Tibiofemoral Contact Mechanics for Anatomic Medial Meniscal Root Repairs in a Cadaveric Model. Am J Sports Med. 2019;47(7):1591-600.
  63. Nakama GY, Kaleka CC, Franciozi CE, Astur DC, Debieux P, Krob JJ, et al. Biomechanical Comparison of Vertical Mattress and Cross-stitch Suture Techniques and Single- and Double-Row Configurations for the Treatment of Bucket-Handle Medial Meniscal Tears. Am J Sports Med. 2019;47(5):1194-202.
  64. Feucht MJ, Grande E, Brunhuber J, Rosenstiel N, Burgkart R, Imhoff AB, et al. Biomechanical comparison between suture anchor and transtibial pull-out repair for posterior medial meniscus root tears. Am J Sports Med. 2014;42(1):187-93.
  65. Kim JH, Chung JH, Lee DH, Lee YS, Kim JR, Ryu KJ. Arthroscopic suture anchor repair versus pullout suture repair in posterior root tear of the medial meniscus: a prospective comparison study. Arthroscopy. 2011;27(12):1644-53.
  66. Faucett SC, Geisler BP, Chahla J, Krych AJ, Kurzweil PR, Garner AM, et al. Meniscus Root Repair vs Meniscectomy or Nonoperative Management to Prevent Knee Osteoarthritis After Medial Meniscus Root Tears: Clinical and Economic Effectiveness. Am J Sports Med. 2019;47(3):762-9.
  67. Chung KS, Ha JK, Ra HJ, Kim JG. A meta-analysis of clinical and radiographic outcomes of posterior horn medial meniscus root repairs. Knee Surg Sports Traumatol Arthrosc. 2016;24(5):1455-68.
  68. Feucht MJ, Kühle J, Bode G, Mehl J, Schmal H, Südkamp NP, et al. Arthroscopic Transtibial Pullout Repair for Posterior Medial Meniscus Root Tears: A Systematic Review of Clinical, Radiographic, and Second-Look Arthroscopic Results. Arthroscopy. 2015;31(9):1808-16.
  69. Lee DW, Ha JK, Kim JG. Medial meniscus posterior root tear: a comprehensive review. Knee Surg Relat Res. 2014;26(3):125-34.
  70. Feucht MJ, Grande E, Brunhuber J, Burgkart R, Imhoff AB, Braun S. Biomechanical evaluation of different suture techniques for arthroscopic transtibial pull-out repair of posterior medial meniscus root tears. Am J Sports Med. 2013;41(12):2784-90.
  71. Woodmass JM, LaPrade RF, Sgaglione NA, Nakamura N, Krych AJ. Meniscal Repair: Reconsidering Indications, Techniques, and Biologic Augmentation. J Bone Joint Surg Am. 2017;99(14):1222-31.
  72. Stärke C, Kopf S, Lippisch R, Lohmann CH, Becker R. Tensile forces on repaired medial meniscal root tears. Arthroscopy. 2013;29(2):205-12.
  73. Lee HI, Park D, Cho J. Clinical and Radiological Results with Second-Look Arthroscopic Findings after Open Wedge High Tibial Osteotomy without Arthroscopic Procedures for Medial Meniscal Root Tears. Knee Surg Relat Res. 2018;30(1):34-41.
  74. Ke X, Qiu J, Chen S, Sun X, Wu F, Yang G, et al. Concurrent arthroscopic meniscal repair during open-wedge high tibial osteotomy is not clinically beneficial for medial meniscus posterior root tears. Knee Surg Sports Traumatol Arthrosc. 2021;29(3):955-65.
  75. Nha KW, Lee YS, Hwang DH, Kwon JH, Chae DJ, Park YJ, et al. Second-look arthroscopic findings after open-wedge high tibia osteotomy focusing on the posterior root tears of the medial meniscus. Arthroscopy. 2013;29(2):226-31.
  76. Jing L, Liu K, Wang X, Wang X, Li Z, Zhang X, et al. Second-look arthroscopic findings after medial open-wedge high tibial osteotomy combined with all-inside repair of medial meniscus posterior root tears. J Orthop Surg (Hong Kong). 2020;28(1):2309499019888836.
  77. Cinque ME, Geeslin AG, Chahla J, Dornan GJ, LaPrade RF. Two-Tunnel Transtibial Repair of Radial Meniscus Tears Produces Comparable Results to Inside-Out Repair of Vertical Meniscus Tears. Am J Sports Med. 2017;45(10):2253-9.

 

The Archives of Bone and Joint Surgery
Volume 10, Issue 5
May 2022
Pages 366-380

  • Receive Date 02 September 2021
  • Accept Date 11 November 2021