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BACKGROUND: Meniscal root tears can lead to early knee osteoarthritis and pain. This study aimed (1) to compare clinical and radiological outcomes between patients who underwent arthroscopic meniscal root repair after meniscal root tears and those who received non-surgical treatment, and (2) to identify whether baseline MRI findings could be potential predictors for future treatment strategies. METHODS: Patients with meniscal root tears were identified from our picture archiving and communication system from 2016 to 2020. Two radiologists reviewed radiographs and MRI studies using Kellgren-Lawrence (KL) grading and a modified Whole Organ MRI Scoring (WORMS) at baseline and follow-up. The median (interquartile range [IQR]) of follow-up radiographs and MRI studies were 134 (44-443) days and 502 (260-1176) days, respectively. MR images were assessed for root tear-related findings. Pain scores using visual analogue scale (VAS) and management strategies (non-surgical vs. arthroscopic root repair) were also collected. Chi-squared tests and independent t-tests were used to assess differences regarding clinical and imaging variables between treatment groups. Logistic regression analyses were performed to evaluate the associations between baseline MRI findings and each future treatment. RESULTS: Ninety patients were included. VAS pain scores were significantly (p

Abstract Background Meniscal root tears can lead to early knee osteoarthritis and pain. This study aimed (1) to compare clinical and radiological outcomes between patients who underwent arthroscopic meniscal root repair after meniscal root tears and those who received non-surgical treatment, and (2) to identify whether baseline MRI findings could be potential predictors for future treatment strategies. Methods Patients with meniscal root tears were identified from our picture archiving and communication system from 2016 to 2020. Two radiologists reviewed radiographs and MRI studies using Kellgren-Lawrence (KL) grading and a modified Whole Organ MRI Scoring (WORMS) at baseline and follow-up. The median (interquartile range [IQR]) of follow-up radiographs and MRI studies were 134 (44–443) days and 502 (260–1176) days, respectively. MR images were assessed for root tear-related findings. Pain scores using visual analogue scale (VAS) and management strategies (non-surgical vs. arthroscopic root repair) were also collected. Chi-squared tests and independent t-tests were used to assess differences regarding clinical and imaging variables between treatment groups. Logistic regression analyses were performed to evaluate the associations between baseline MRI findings and each future treatment. Results Ninety patients were included. VAS pain scores were significantly (p

Background: Medial meniscal root repairs are devastating injuries that can cause long-term knee problems if not properly addressed. Some common issues when addressing these injuries surgically include the "bungee-cord" effect seen with implants that sit too far from the tibial plateau surface and loss of tension on the sutures after cycling of the knee after the repair. This video will discuss the presentation of a patient with a medial meniscal root repair treated with a novel technique to counteract these aforementioned issues. Indications: Based on the patient's medial meniscal root tear and minimal arthritis seen on radiograph, he was indicated for a meniscal root repair to prevent meniscal extrusion and reinforce normal meniscal hoop stresses to limit progression of his arthritis. Technique Description: This technique uses a novel re-tensionable all-suture anchor through a transtibial tunnel with 2 repair sutures through the meniscal root that sits just below the tibial plateau, allowing the surgeon the ability to re-tension the implant after cycling the knee. Results: Arthroscopic repair of the medial meniscal root allowed the patient to return to his previous level of activity. Discussion/Conclusion: In this case, arthroscopic medial meniscal root repair can yield good results in patients to get them back to their previous level of activity while minimizing the chance of rapid arthritic progression that is typically seen with nonoperative management of these injuries. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication. [ABSTRACT FROM AUTHOR]

Objective: Rare disease Background: Posterior meniscal root avulsions can cause meniscal extrusion, joint space narrowing, and progressive knee arthritis. Iatrogenic posterior meniscal root avulsions after malpositioning of the transtibial tunnels during anterior cruciate ligament (ACL) reconstruction can account for poor long-term outcomes seen in some patients following ACL reconstruction. Therefore, correct transtibial tunnel placement during ACL reconstruction is essential to avoid iatrogenic meniscal damage. Case Report: A 32-year-old man presented with 1 year of right knee pain and instability following a non-contact twisting injury sustained while playing soccer. An ACL tear with no meniscal involvement was diagnosed at an outside institution. A double-bundle reconstruction was performed at that time. Three months after surgery, a medial partial meniscectomy was performed after a medial meniscal tear and failure to reduce initial symptoms during the index procedure. Advanced imaging at our institution 6 months later demonstrated an iatrogenic lateral posterior meniscal root avulsions after malpositioning of the transtibial tunnels. Given the ACL graft integrity upon arthroscopic evaluation, the root tear was repaired using a 2-tunnel transtibial pull-out technique. Advanced imaging 1 year after surgery showed a well-maintained meniscal repair with no extrusion. Conclusions: Accurate transtibial tunnel placement during ACL reconstructive surgery is vital to avoid meniscal root detachment and the associated complications resulting in poor patient outcomes from this iatrogenic injury. Clinicians treating patients with a history of cruciate ligament reconstruction presenting with postoperative pain and instability should consider this pathology in their differential diagnosis. [ABSTRACT FROM AUTHOR]

Meniscal lesions often occur in association with anterior cruciate ligament (ACL) tears at the moment of the injury or, secondarily, as a consequence of knee instability. Both ACL and meniscus lesions are associated with a higher risk of osteoarthritis. Adequate treatment of these lesions reduces the rate of degenerative changes in the affected knee. Meniscal tears should be addressed concomitantly with ACL reconstruction and the treatment must be oriented towards preserving the meniscal tissue anytime this is possible. Several options for approaching a meniscus tear are available. The meniscal suture should always be considered, and, if possible, meniscectomy should be the last choice. "Masterly neglect" is a valuable option in selected cases. [ABSTRACT FROM AUTHOR]

Abstract Background To arthroscopically evaluate the incidence of lateral meniscal root avulsion (LMRA) and associated intra-articular injuries in patients undergoing anterior cruciate ligament (ACL) reconstruction. Materials and Methods From April 2014 to March 2017, 532 consecutive patients were diagnosed as having an ACL injury and underwent arthroscopic ACL reconstruction. The diagnosis of LMRA was made arthroscopically. The effects of gender, activity, grade of laxity, time from injury, and concomitant meniscal lesions were analyzed. Results Among 532 patients, 497 (93.4%) underwent primary ACL reconstruction and 35 (6.5%) underwent revision procedures. 383 were acute or subacute injuries (less than 6 months from injury to surgery) and 149 chronic (more than 6 months). Average age was 30.4 years (DS: ± 11.04); there were 422 (79.3%) males and 110 (20.6%) females. A LMRA associated with the ACL injury was detected in 72 cases (13.5%), with a significant prevalence observed in males ( $${\chi ^2}$$ χ 2 = 4.65; P = 0.031, statistically significant). In the 149 patients with a chronic injury, 27 patients had LMRA (18.1%), while 45 of the 383 patients with an acute or subacute injury had LMRA (11.7%). There was a tendency, albeit not significant ( $${\chi ^2}$$ χ 2 = 3.721; P = 0.054), for the prevalence to increase with time since the initial ACL injury. LMRA was significantly associated ( $${\chi ^2}$$ χ 2 = 7.81; P = 0.006) with a meniscocapsular tear of the posterior horn of the medial meniscus (ramp lesion). No other significant associations, such as with severity of A-P translation (as measured by KT-2000) or activity level, were detected. Conclusion LMRA is a relatively common injury associated with both acute and chronic ACL tears. A relatively high incidence in cases of chronic ACL insufficiency suggests that LMRAs do not heal spontaneously or that they may appear with time, even when absent at the time of the initial injury. Level of evidence Level III, cross-sectional study.

Background: Prospective evaluation of clinical outcomes after posterior meniscal root repair utilizing a transtibial pullout technique is limited, and factors that may contribute to outcomes are unclear. Hypothesis: It was hypothesized that there would be an overall significant improvement in outcomes after root repair and that differences in clinical outcomes would correlate with age, body mass index (BMI), sex, and meniscal extrusion. Study Design: Case-control study; Level of evidence, 3. Methods: Consecutive patients undergoing transtibial medial or lateral meniscal root repair were enrolled prospectively at 2 orthopaedic centers between March 2017 and January 2019. Pre- and postoperative magnetic resonance imaging (MRI) were obtained to assess for meniscal healing, quantification of extrusion, articular cartilage grade, and subchondral bone changes. Patient-reported outcomes including International Knee Documentation Committee (IKDC) scores, Tegner activity scale, and visual analog scale (VAS) for pain were collected preoperatively and 2 years postoperatively. Patients were then subdivided by clinical and demographic characteristics to determine factors associated with clinical outcomes. Results: Included were 45 patients (29 female, 16 male; mean age, 42.3 ± 12.9 years; mean BMI, 31.6 kg/m2) who underwent 47 meniscal root repairs (29 medial and 16 lateral; 2 had both). Significant improvements at 2-year follow-up were seen in IKDC score (41.1 vs 78.4; P <.001), Tegner activity level (3 vs 4; P <.001), and VAS pain (2.8 vs 0.7; P <.001). BMI, preoperative malalignment, cartilage status, and progressive meniscus extrusion (Δ = 0.7 mm) did not have a negative impact on IKDC and Tegner scores 2 years postoperatively. Age greater than or equal to 50 years and extrusion pre- and postoperatively were associated with decreased Tegner scores. Progressive meniscal extrusion was associated with a decreased overall improvement in Tegner scores. Conclusion: Transtibial root repair for medial and lateral posterior meniscal root tears demonstrated significantly improved clinical outcomes at 2 years postoperatively. Increased age, increased BMI, cartilage status, and meniscal extrusion did not have a negative impact on short-term functional outcomes (IKDC), but age greater than or equal to 50 years and extrusion negatively influenced patient activity level (Tegner). Registration: NCT03037242 (ClinicalTrials.gov identifier). [ABSTRACT FROM AUTHOR]

Background: To arthroscopically evaluate the incidence of lateral meniscal root avulsion (LMRA) and associated intra-articular injuries in patients undergoing anterior cruciate ligament (ACL) reconstruction.Materials and Methods: From April 2014 to March 2017, 532 consecutive patients were diagnosed as having an ACL injury and underwent arthroscopic ACL reconstruction. The diagnosis of LMRA was made arthroscopically. The effects of gender, activity, grade of laxity, time from injury, and concomitant meniscal lesions were analyzed.Results: Among 532 patients, 497 (93.4%) underwent primary ACL reconstruction and 35 (6.5%) underwent revision procedures. 383 were acute or subacute injuries (less than 6 months from injury to surgery) and 149 chronic (more than 6 months). Average age was 30.4 years (DS: ± 11.04); there were 422 (79.3%) males and 110 (20.6%) females. A LMRA associated with the ACL injury was detected in 72 cases (13.5%), with a significant prevalence observed in males ([Formula: see text] = 4.65; P = 0.031, statistically significant). In the 149 patients with a chronic injury, 27 patients had LMRA (18.1%), while 45 of the 383 patients with an acute or subacute injury had LMRA (11.7%). There was a tendency, albeit not significant ([Formula: see text] = 3.721; P = 0.054), for the prevalence to increase with time since the initial ACL injury. LMRA was significantly associated ([Formula: see text] = 7.81; P = 0.006) with a meniscocapsular tear of the posterior horn of the medial meniscus (ramp lesion). No other significant associations, such as with severity of A-P translation (as measured by KT-2000) or activity level, were detected.Conclusion: LMRA is a relatively common injury associated with both acute and chronic ACL tears. A relatively high incidence in cases of chronic ACL insufficiency suggests that LMRAs do not heal spontaneously or that they may appear with time, even when absent at the time of the initial injury.Level Of Evidence: Level III, cross-sectional study. [ABSTRACT FROM AUTHOR]

Background: The lateral meniscus posterior root (LMPR) lesion further decreases dynamic knee stability after anterior cruciate ligament (ACL) injury owing to the loss of the "wedge effect" maintained by the posterior horn of the lateral meniscus. However, the effect of LMPR lesions on the static tibiofemoral relationship in extension after ACL injuries is not determined. Purpose: To (1) determine the effect of LMPR lesions on anterior tibial subluxation of the lateral compartment (ATSLC) in extension in patients with ACL injuries and to (2) identify the LMPR-related factors associated with excessive ATSLC in extension. Study Design: Cohort study; Level of evidence, 3. Methods: Between January 2015 and December 2017, 405 consecutive patients with diagnosed ACL injuries who underwent primary ACL reconstructions were retrospectively reviewed. Among them, 45 patients with combined ACL injuries and LMPR lesions (ACL+LMPR group) and 51 patients with isolated ACL injuries (ACL group) were identified. Values of ATSLC in extension were measured on preoperative supine magnetic resonance imaging and classified into high grade (≥6 mm) and low grade (<6 mm). The mean ATSLC in extension and the proportion of patients with high-grade ATSLC in extension were compared between the groups by univariate analysis. In the ACL+LMPR group, predictors of high-grade ATSLC in extension—including age, sex, body mass index, affected side, cause of injury, period from injury (<12 or ≥12 weeks), LMPR lesion pattern (radial tear or root avulsion), and meniscofemoral ligament integrity (intact or impaired)—were assessed by univariate analysis and multivariate logistic regression analysis. Results: The mean ATSLC in extension in the ACL+LMPR group was significantly greater than that in the ACL group (5.6 mm vs 3.1 mm; P =.001). The proportion of patients with high-grade ATSLC in extension in the ACL+LMPR group was also significantly larger than that in the ACL group (44.4% vs 15.7%; P =.002). In addition, the root avulsion (instead of radial tear) (odds ratio, 28.750; 95% CI, 2.344-352.549; P =.009) and the period from injury ≥12 weeks (odds ratio, 17.095; 95% CI, 1.207-242.101; P =.036) were determined to be the 2 independent predictors of high-grade ATSLC in extension. However, age, sex, body mass index, affected side, cause of injury, and meniscofemoral ligament integrity were not. Conclusion: After ACL injuries, concomitant LMPR lesion further increased ATSLC in extension. Chronic LMPR avulsion was associated with high-grade ATSLC in extension. [ABSTRACT FROM AUTHOR]

Background: Meniscal tears, including tears at the root attachment, have been associated with tears of the anterior cruciate ligament (ACL) in both primary and revision settings. However, there is a paucity of literature reporting the healing rates of meniscal repair during 2-stage revision ACL reconstruction (ACLR). Purpose: To evaluate the healing rates of meniscal repairs performed during 2-stage revision ACLR in ACL-deficient knees and to report the incidence of meniscus root tears in patients undergoing primary ACLR as compared with revision ACLR. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent primary and revision ACLR by a single surgeon were retrospectively identified. Revision ACLRs were grouped according to 1- or 2-stage ACLR. Meniscal tears were grouped according to laterality (medial, lateral) and location of tears. Meniscal repair technique was recorded, including transtibial or inside-out. Meniscal repair healing was assessed via second-look arthroscopy at the time of second-stage revision ACLR. Results: There were 1168 patients identified who underwent ACLR: 851 primary and 317 revision procedures. Sixty-four patients underwent meniscal repair during first-stage bone grafting in ACL-deficient knees, with an overall healing rate of 86%. The healing rates were 82.3% for meniscus root tears via the transtibial repair technique and 92.4% for meniscal peripheral tears via the inside-out repair technique. Meniscus root tears had overall incidences of 15.5% and 26.2% in primary and revision ACLRs, respectively. The incidence of lateral meniscus posterior root tears was approximately 4 times higher than of medial meniscus posterior root tears in both primary (12.2% vs 3.2%) and revision (20.5% vs 5.6%) ACLRs. Conclusion: A high incidence of meniscus root tears was found in patients undergoing revision ACLRs as compared with primary ACLRs. Meniscal repairs have a high rate of healing and success when performed during the first stage of revision ACLR in ACL-deficient knees. [ABSTRACT FROM AUTHOR]

Meniscal root lesion is defined as an avulsion of the tibial insertion of the meniscus or a radial tear close to the meniscal insertion, which is commonly observed at the posterior region in the clinical practice. Although a number of biomechanical and clinical studies have shown the importance of the integrity of the posterior meniscal roots, the appropriate treatment is still controversial. The purposes of this review are to develop a current understanding of how the posterior meniscal root functions and to review the available treatment options for posterior meniscal root lesion.

The posterior medial meniscal root (PMMR) experiences variable and multiaxial forces during loading. Current methods to measure these forces are limited and fail to adequately characterize the loads in all three dimensions at the root. Our novel technique resolved these limitations with the installation of a 3-axis sensing construct that we hypothesized would not affect contact mechanics, would not impart extraneous loads onto the PMMR, would accurately measure forces, and would not deflect under joint loads. Six cadaveric specimens were dissected to the joint capsule and a sagittal-plane, femoral condyle osteotomy was performed to gain access to the root. The load sensor was placed below the PMMR and was validated across four tests. The contact mechanics test demonstrated a contact area precision of 44 mm2 and a contact pressure precision of 5.0 MPa between the pre-installation and post-installation states. The tibial displacement test indicated an average bone plug displacement of < 1 mm in all directions. The load validation test exhibited average precision values of 0.7 N in compression, 0.5 N in tension, 0.3 N in anterior-posterior shear, and 0.3 N in medial–lateral shear load. The bone plug deflection test confirmed < 2 mm of displacement in any direction when placed under a load. This is the first study to successfully validate a technique for measuring both magnitude and direction of forces experienced at the PMMR. This validated method has applications for improving surgical repair techniques and developing safer rehabilitation and postoperative protocols that decrease root loads. [ABSTRACT FROM AUTHOR]

Unlabelled: The posterior lateral (PL) meniscal root plays an essential role in ensuring the health of the articular cartilage of the knee joint. Injuring the PL meniscal root has been demonstrated to result in significant deleterious changes to tibiofemoral contact mechanics. Anatomic studies have reported that the posterolateral bundle of the anterior cruciate ligament (ACL) and PL root lie in close proximity on the tibial plateau. Therefore, during a double-bundle ACL reconstruction, the PL root may be inadvertently injured during the reaming of the posterior ACL double-bundle reconstruction tibial tunnel that is intended to recreate the posterolateral bundle of the ACL. This case report describes an occurrence of iatrogenic injury to the PL root due to a posteriorly malpositioned double-bundle ACL tibial tunnel. This report is the first known description of this mechanism of injury in the literature.Level Of Evidence: Case report, Level IV. [ABSTRACT FROM AUTHOR]

A rare case of acute avulsion of both posterior meniscal roots concomitant with an acute anterior cruciate ligament (ACL) tear in a professional soccer player is described. While avulsion of the lateral meniscal root has been extensively reported in association with ACL injuries, medial root avulsion has never been reported in association with acute ACL. A review of the video documentation of the match accident revealed the exact mechanism of injury was a forceful external rotation of the standing limb. [ABSTRACT FROM AUTHOR]

Background: Intramedullary (IM) nailing is the treatment of choice among orthopaedic surgeons for tibial shaft fractures. However, because of the close proximity of the nail's insertion site to the anterior medial (AM) meniscal root on the tibial plateau, there is increased risk of iatrogenic injury to the meniscal root during nailing. Purpose: To quantify the area of the AM meniscal root footprint damaged by IM tibial reaming and determine its subsequent effects on the ultimate failure load in female versus male knees. Study Design: Controlled laboratory study. Methods: Twelve matched pairs (6 male and 6 female pairs; average age, 50.2 years) of human cadaveric knees were randomly assigned to native and reamed groups. In the reamed group, knees were reamed within the "safe zone" according to current guidelines for IM tibial nail insertion (3 mm lateral to the center of the tibial tubercle and adjacent to the anterior margin of the tibial plateau). The attachment areas and ultimate failure load were quantified and compared with paired knees in the native group. Results: Intra-articular reaming within the "safe zone" for IM tibial nail insertion did not significantly decrease the AM root attachment area or ultimate failure load in male specimens, as only 2 of the 6 knees were damaged by reaming. In contrast, all 6 of the AM roots in the female knees were damaged by reaming, and on average, reaming decreased the female AM root attachment area by 19% and significantly decreased ultimate failure load by 37% (P = .028). There was a strong negative correlation (R² = 0.77) between reamed tunnel-AM root overlap area and medial-lateral width in female but not in male knees. Conclusion: Standard reaming for an IM tibial nail induced significant damage to the AM meniscal root in smaller, female specimens, whereas larger, male specimens were not affected. Clinical Relevance: These findings may suggest that improvements in current guidelines and surgical techniques are warranted to prevent iatrogenic injury to the AM meniscal root during intramedullary reaming for tibial shaft fractures in females and in smaller patients. [ABSTRACT FROM AUTHOR]

Background: Current methods of the transtibial pull-out meniscal root repair significantly displace under cyclic loading in porcine models but have not been evaluated in human models. One potential explanation for the displacement is that a single transtibial tunnel may not fully restore the attachment of the entire posterior medial meniscal root. Purpose/Hypothesis: The purpose of this study was to biomechanically evaluate the transtibial pull-out technique in a human cadaveric model using either 1 or 2 transtibial bone tunnels. The hypothesis was that a transtibial pull-out technique using 2 transtibial bone tunnels would confer superior biomechanical properties in comparison to an iteration using 1 transtibial bone tunnel. Study Design: Controlled laboratory study. Methods: Ten matched pairs of male human cadaveric knees (average age, 52.7 years) were randomly assigned (1 each of the pair) to 2 groups consisting of a transtibial pull-out technique using either 1 or 2 transtibial bone tunnels. The knees were cyclically loaded for 1000 cycles from 10 to 30 N at 0.5 Hz, representing the loads experienced during a typical meniscal root repair post- operative rehabilitation program, and then pulled to failure at a rate of 0.5 mm/s. Results: Differences between 1- and 2-tunnel repair groups were neither statistically nor clinically significant with respect to displacement or ultimate failure load. On average, the 1- and 2-tunnel repair groups resulted in 3.32 mm and 3.23 mm of displacement, respectively, after 1000 testing cycles. At 1, 100, 500, and 1000 testing cycles, displacement was not significantly different between groups (P > .799). The 2-tunnel repair technique resulted in a 10.2% higher ultimate failure load (135 N vs 123 N); however, this was not significant (P = .333). Conclusions: Similar biomechanical properties were seen between transtibial pull-out repairs using either 1 or 2 transtibial bone tunnels in a human cadaveric model. Both repair groups exceeded the 3-mm threshold for nonanatomic displacement. Clinical Relevance: This study indicates that a newly proposed iteration of the transtibial pull-out repair technique using a second transtibial tunnel, which theoretically restores more of the posterior medial meniscal root, was almost identical to the current clinical standard involving a single transtibial tunnel. As the importance of repairing meniscal root tears is increasingly recognized, further studies on new iterations of both techniques are warranted to minimize the risk of displacement caused by early motion in the initial postoperative rehabilitation period. [ABSTRACT FROM AUTHOR]

The article presents research which dealt with the radiographic location of the posterior and anterior root attachments of lateral and medial menisci. Topics covered include the importance of anatomic root placement to boost native meniscal function while a patient is undergoing meniscal root repair. Also mentioned are the guidelines for boost the consistency as well as accuracy of anatomic root repair.

Magnetic resonance imaging (MRI) has become an increasingly important imaging technique in osteoarthritis (OA) research, and is widely used in the ongoing endeavor to understand the pathogenesis of OA and to develop structure and disease-modifying OA drugs. MRI offers semiquantitative, quantitative and compositional evaluation of knee OA, and enables visualization of tissues that are not seen by radiography, including but not limited to cartilage, meniscus, bone marrow lesions, synovitis, and muscles. It is now recognized that contrast-enhanced MRI enables more accurate evaluation of synovitis than MRI without contrast. Because of its ability to visualize multiple pain-related tissue pathology in three dimensions, MRI is the best modality for imaging of OA. [ABSTRACT FROM AUTHOR]

Background: Tears of the medial meniscus posterior root can lead to progressive arthritis, and its management has no consensus. The aim of our study was to evaluate the effect of supervised exercise therapy on patients with medial meniscus posterior root tears. Materials and methods: Between January 2005 and May 2007, 37 patients with this tear verified by magnetic resonance imaging (MRI) and osteoarthritis grade 1-2 by radiographic examination were treated by a short course of analgesics daily for up to 6 weeks and then as required during follow-up, as well as a 12-week supervised exercise program followed by a home exercise program. Final analysis was performed for 33 patients, average age 55.8 (range 50-62) years and average follow-up of 35 (range 26-49) months. Patients were followed up at 3, 6, and 12 months and yearly thereafter using the Lysholm Knee Scoring Scale, Tegner Activity Scale (TAS), and visual analog scale (VAS). The analysis was performed using one-way analysis of variance (ANOVA) and Pearson's correlation coefficient to determine the relationship between Lysholm score and body mass index (BMI). Results: Patients showed an improvement in Lysholm score, TAS, and VAS, which reached maximum in 6 months and later was accompanied by a decline. However, scores at the final follow-up were significantly better than the pretherapy scores. There was also a progression in arthritis as per Kellgren and Lawrence radiographic classification from median 1 preintervention to median 2 at the final follow-up. A correlation between BMI and Lysholm scores was seen ( r = 0.47). Conclusion: Supervised physical therapy with a short course of analgesics followed by a home-based program results in symptomatic and functional improvement over a short-term follow-up; however, osteoarthritis progression continues and is related to BMI. [ABSTRACT FROM AUTHOR]

Background In meniscal root tears (MRTs), the disruption of collagen fibers that provide hoop strength results in extrusion of the menisci, altering their biomechanical properties. Clinical diagnosis is difficult, but magnetic resonance imaging usually allows to identify the lesion. Located into the vascularized zone of the meniscus, management is preferentially arthroscopic, aimed at repairing the lesions with arthroscopic transosseous sutures or suture anchors. Sources of data PubMed, Cochrane Library, Google Scholar and Ovid Medline were searched in July 2012 to find literature on MRT tears. We reviewed the literature on biomechanics, imaging features and current treatments of these tears. Twenty-seven appropriate articles were identified and included in the study: 6 biomechanical studies, 11 imaging-based investigations for diagnosis, 1 study on clinical diagnosis and 9 studies about treatment. Areas of agreement MRTs are infrequent, accounting for 10.1% of all arthroscopic meniscectomies. When the damage occurs to the roots, the transmission of the circumferential hoop tension is impaired and, consequently, the menisci tend to be displaced anteriorly and posteriorly, altering the biomechanics and possibly the kinematics of the knee. Areas of controversy Although the importance of the integrity of the meniscal roots is well established, their diagnosis and treatment are still controversial. Growing points Biomechanical and clinical studies demonstrate that surgical repair of acute, traumatic meniscal root injuries fully restores the biomechanical features of the menisci, leading to pain relief and functional improvement. The current available surgical techniques for the meniscal root repair (suture anchors and pullout repair) are comparable. Level of evidence IV. [ABSTRACT FROM AUTHOR]

Meniscal root tears represent radial tears or avulsions of the meniscal cartilage at the tibial attachment site that profoundly affect meniscal biomechanics and kinematics. Meniscal root tears have the functional effect of a total meniscectomy and can lead to rapid degenerative change with development of early knee osteoarthritis (OA). A growing range of arthroscopic surgical techniques have been developed to repair meniscal root tears with the aim of restoring joint kinematics and contact pressures and delaying the development of OA. With increased understanding of the anatomy and biomechanics of the meniscal root, meniscal root injury repair has become the treatment of choice in knees with nonadvanced OA. This article reviews the anatomy and biomechanics of the meniscal roots, clinical and imaging diagnostic criteria of meniscal root tears, correlation between arthroscopy and MRI in the diagnosis and classification of meniscal root tears, and expected and abnormal MRI findings after meniscal root repair. Familiarity with MRI signs and classifications of meniscal root tears, as well as with root repair surgical techniques, can aid radiologists in correctly reporting preoperative and postoperative MRI findings.

Purpose: The goal of the present report was to describe a new clinical sign to make a clinical diagnosis of meniscal extrusion related to medial meniscal root avulsion. Methods: Description of an easy clinical sign to detect extrusion of the medial meniscus at the anteromedial joint line. A varus stress test was applied in full extension before and after transosseous repair of an isolated traumatic avulsion of the posterior root of the medial meniscus in a 21-year-old patient. The clinical sign was verified by sectioning of the meniscotibial ligament during knee arthroplasty surgery in 3 patients. Results: With a deficient posterior root, the clinical sign was positive, showing anteromedial extrusion under varus stress. After repair and at clinical follow-up, extrusion was normalized. Conclusion: Making the clinical diagnosis of medial meniscus extrusion after knee injury by applying a simple varus stress test to the knee and palpating the anteromedial meniscal extrusion might help physicians to suspect a medial meniscus root tear in the early stages after the injury as well as to evaluate its reduction after repair. A varus stress test in full extension should be performed systematically in patients where a root tear of the medial meniscus is suspected as well as after surgery to evaluate the success of the repair. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Background: Meniscal root tears have attracted increasing interest in recent years. Fixation is an important factor for rehabilitation and avoidance of early failure. Suture fixations have been the most commonly used techniques. The current study aimed to evaluate the maximum failure load of the native meniscal roots (anteromedial, posteromedial, anterolateral, and posterolateral) and of 3 commonly used meniscal root fixation techniques (2 simple stitches, modified Kessler stitch, and loop stitch).Hypotheses: (1) There will be no difference in maximum failure load between the native meniscal roots. (2) The loop stitch will sustain the greatest maximum load to failure, followed by the modified Kessler stitch and the 2 simple stitches. (3) The maximum failure load of the native meniscal roots will not be restored by the tested fixation methods.Study Design: Controlled laboratory study.Methods: The maximum failure load of the 4 human native meniscal roots was evaluated using 64 human meniscal roots. Additionally, the maximum failure load of the 3 fixation techniques was evaluated on 24 meniscal roots: (1) 2 simple stitches, (2) modified Kessler stitch, and (3) loop stitch using a suture shuttle.Results: The average maximum failure load of the native meniscal roots was 594 ± 241 N (anterolateral: 692 ± 304 N; posterolateral: 648 ± 140 N; anteromedial: 407 ± 180 N; posteromedial: 678 ± 200 N). The anteromedial root was significantly weaker than the posterolateral and posteromedial roots (P = .04 and P = .01, respectively). Regarding fixation techniques, the maximum failure load of the 2 simple stitches was 64.1 ± 22.5 N, the modified Kessler stitch was 142.6 ± 33.3 N, and the loop was 100.9 ± 41.6 N. None of the fixation techniques recreated the strength of the native roots.Conclusion: The native anterolateral root was the strongest meniscal root, and the anteromedial root was the weakest meniscal root. Regarding primary fixation strength, the modified Kessler stitch was the strongest technique compared with the loop and the 2 simple stitches.Clinical Relevance: None of our tested fixation methods restored the strength of native meniscal roots. Thus, rehabilitation after meniscal root fixation should proceed cautiously. [ABSTRACT FROM PUBLISHER]

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Abstract: Tears of the posterior root of the medial meniscus are becoming increasingly recognized. Early identification and treatment of these tears help halt the progression of cartilage degeneration and osteoarthritis of the knee. Repair of these tears is essential for recreating the hoop stress of the medial meniscus. In this note, we describe a successful arthroscopic technique to repair this lesion. A posteromedial portal is established by which two 2-0 PDS sutures are placed through the meniscus root and pulled down through a trans-tibial tunnel and fixed using an EndoButton distally along the anterolateral cortex of the tibia. This has been performed successfully in five patients with no complications. [Copyright &y& Elsevier]

Abstract: Meniscal tears within the body of the meniscus or at the meniscocapsular junction represent a well-understood and manageable condition encountered in clinical practice. In comparison, however, meniscal root tears (MRTs) often go unnoticed and represent a unique injury pattern with unique biomechanical consequences. Though first described decades ago, improvements in magnetic resonance imaging and arthroscopy have only recently enhanced our diagnostic and treatment capabilities with regard to MRTs. This review contains an anatomic description of the roots including their significance in meniscal function as well as the consequences of their loss. In addition, how to properly identify MRTs and when it is appropriate to surgically repair them are described. Finally, we review the surgical techniques available in the existing literature and present an illustrative case. [Copyright &y& Elsevier]

The anatomy of the lateral meniscus underlies the understanding of its unique biomechanics. Moreover, the knowledge of its microscopic structure, its vascularization and its ligament insertions can make us understand the rationale for its surgical treatment. It is well known as the respect of the anatomy leads to better results in reconstructive surgery. Knowing the differences in the shape and in the areas of insertion of the meniscal roots can be useful in case of reinserting a root or when performing a meniscal transplant. Learning about the capsular insertions, the anchoring ligaments and the areas of greatest mobility of the lateral meniscus is useful during meniscal repair and replacement surgery. This information can let us choose the most appropriate technique and the best device to face any kind of meniscal lesion. In this article, we will consider both the micro and the macro meniscal structure in order to be able to give a description as complete as possible of this fundamental structure. We will consider the interrelation of the meniscus with the neighboring anatomical structures with which it contributes to the biomechanical control of the joint. It is important to understand the interrelation with both anterior and posterior cruciate ligament (PCL) given that frequently a combined meniscal and ligamentous reconstruction is necessary., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://aoj.amegroups.com/article/view/10.21037/aoj-20-118/coif). The series “The Lateral Meniscus” was commissioned by the editorial office without any funding or sponsorship. JCM received payment for lectures from Smith & Nephew. The authors have no other conflicts of interest to declare., (2022 Annals of Joint. All rights reserved.)

Objective: The purpose of this study was to characterize meniscal ossicles and their association with meniscal root tears., Materials and Methods: A two-center retrospective assessment of 65 knee MRI studies with meniscal ossicles was performed. The relationship of the ossicle to the meniscal root and horn was assessed along with other findings of internal derangement of the knee., Results: Meniscal ossicles were identified in patients ranging from 23 to 80 years old. The ossicles were located within the posterior horn and root of the medial meniscus in 57 of 65 (88%) examinations. Associated meniscal tears were seen at the site or adjacent to the ossicle in all but one examination (98%). Meniscal extrusion was present in 52% (34/65) of examinations. Associated findings included articular cartilage loss, which was severe in 51% (33/65) of examinations. Anterior cruciate ligament injury or prior anterior cruciate ligament reconstruction surgery was also identified in 58% (38/65) of examinations., Conclusion: Our findings show that the vast majority of meniscal ossicles are associated with posterior horn or meniscal root tears and a high incidence of focal articular cartilage loss as well as anterior cruciate ligament tears.