Meniscus Root Repair Success
Meniscus root repair demonstrates superior outcomes compared to debridement or nonoperative management, with approximately 80% success rates at 2 years and better long-term functional outcomes, though all treatment modalities show improvement in pain and function after 12 months. 1, 2, 3
Success Rates and Functional Outcomes
Meniscal repair achieves approximately 80% success at 2-year follow-up, with evidence showing better patient-reported outcomes, superior activity levels, and lower failure rates compared to meniscectomy. 1, 2 For meniscus root tears specifically, arthroscopic repair demonstrates better functional outcomes at 12 months when compared with partial meniscectomy and nonoperative management. 3
All treatment options (repair, debridement, or nonoperative management) improve functional scores after more than 12 months, but repair appears to provide the most sustained benefit. 3
Pain Relief and Quality of Life
Root repair restores joint biomechanics to within normal limits and demonstrates high patient satisfaction rates. 4, 5 The procedure is particularly effective for symptomatic medial meniscus root tears with minimal arthritis that have failed nonoperative treatment. 4
The most common presenting symptoms that improve after repair include posterior knee pain, joint line tenderness (especially with deep squatting), and popping sounds during light activities. 5
Radiographic and Structural Outcomes
Arthroscopic repair may result in slower progression of radiological deterioration compared with meniscectomy and nonoperative management. 3 However, radiographic progression of osteoarthritis occurs in all treatment groups, though there is evidence this progression is delayed after repair. 3
Meniscus root tears interrupt circumferential fibers and lead to failure of normal meniscal function to convert axial loads into transverse hoop stresses—repair addresses this biomechanical deficit. 5
Patient Selection Criteria
Active patients, regardless of age, should be considered for meniscal root repair. 5 Current literature does not support excluding patients from root repair based on age alone. 3
Specific Indications for Root Repair:
- Acute, traumatic root tears in patients with nearly normal or normal cartilage 5
- Chronic symptomatic root tears in young or middle-aged patients without significant preexisting osteoarthritis 5
- Lateral root tears associated with ACL tears 4
- Symptomatic medial meniscus root tears with minimal arthritis that have failed nonoperative treatment 4
Predictors of Poor Outcomes:
Technical Considerations
The transosseous meniscal root repair technique is most commonly used, with the advantage of reducing and fixing the meniscal root to the broad anatomic footprint to maximize healing potential. 5 Transtibial tunnels may contribute to the release of biological factors that enhance healing. 5
Important Caveats
Reoperation rates are higher after meniscal repair compared with arthroscopic partial meniscectomy, though long-term follow-up demonstrates better clinical outcomes and less severe degenerative changes. 6 This requires careful patient counseling about the trade-off between short-term reoperation risk and long-term joint preservation.
Careful patient selection and repair technique are required, with good compliance to post-operative rehabilitation, which often consists of bracing and non-weight bearing for 4-6 weeks. 2
The current evidence is limited by the paucity of high-quality studies, with most being level 3 and 4 evidence. 3 Further randomized sham-controlled trials are needed to definitively compare treatment strategies.