Reviewed by Dr Vishal Pai
Meniscal root repair reattaches the meniscus to the bone when its anchor point, called the root, has torn. This page covers who it suits and who it does not, what the operation involves, recovery, results and risks.
At a Glance
- A meniscal root tear pulls the meniscus away from its anchor on the shin bone, so it can no longer cushion the knee properly.
- Root repair is keyhole surgery that reattaches the root through a small tunnel in the shin bone (tibia).
- It suits people with little or no arthritis, whether the root tore in an injury or through wear. It is not usually helpful once arthritis is established, and other wear-related meniscal tears are managed with physiotherapy first.
- You will keep weight off your leg for 6 weeks after surgery, and a return to sport takes 4 to 6 months.
- A repair does not reverse arthritis, and some people still develop arthritis over time.
What is meniscal root repair?
The meniscus acts like a shock absorber in the knee, protecting the cartilage. It is C-shaped, and each knee has a meniscus on the inside (medial) and on the outside (lateral). Each meniscus has two anchor points where it attaches to the bone, called the root attachments. A meniscal root tear is a specific type of meniscus injury where this attachment to the bone is disrupted.
This small attachment plays a critical role in how the knee handles load. Most meniscal tears do not have this effect, but a root tear is different. Without a functioning root, the meniscus can no longer spread load across the joint. It shifts out of position (called extrusion), and the pressure on the cartilage rises. Laboratory studies show that a root tear overloads the cartilage about as much as losing the whole meniscus, and that a repair brings the pressure back towards normal. [1]
This is why root tears are often associated with ongoing pain that does not settle and the early development of arthritis in that part of the knee. Meniscal root repair aims to restore the attachment, preserving the function of the meniscus and protecting the joint over time.
Who might need meniscal root repair?
Not every root tear needs surgery. Physiotherapy, activity changes, weight management and simple pain relief can settle symptoms in some people.
Dr Vishal Pai tends to recommend a repair when there is no or minimal arthritis and symptoms persist despite rehabilitation. This includes many root tears that happen through wear rather than an injury.
A repair is not usually recommended when:
- Arthritis is already established, because repair does not reverse it. Worn cartilage and bow-legged (varus) alignment of more than 5 degrees are linked with poorer results. [2]
- The tear is an ordinary degenerative meniscal tear that does not involve the root. These are managed with physiotherapy first.
In a bow-legged knee, a repair can be combined with a realignment osteotomy to take load off the inner side of the knee, which may help the repair heal. [3]
What is involved in meniscal root repair?
The aim of surgery is to restore the meniscus to its natural attachment on the bone. The steps involved include:
1. Diagnostic arthroscopy
Two or three small cuts (less than 1 cm), called portals, are made to pass a camera and surgical tools into the knee. The whole joint is inspected for damage. The root tear is confirmed, and the condition of the cartilage is noted.
2. Meniscal root repair
This is most commonly performed using a transtibial pull-out technique. Two or three stitches are passed through the torn root. A small tunnel is drilled through the shin bone (tibia) to the point where the root attaches inside the knee. The stitches are passed down the tunnel and secured to the tibia with a bone anchor or a small anchoring plate. This holds the meniscus against the bone so that it can heal, and aims to restore its function as a shock absorber.
How long does it take to recover from meniscal root repair?
The recovery is more structured than after a simple meniscectomy. For the first 6 weeks you keep weight off the operated leg, using crutches or a frame, and deep bending is restricted. These restrictions give the meniscus the best chance of healing back to the bone. Rehabilitation then rebuilds the strength lost while you were off your leg. Swelling can last up to 3 months. As a rough guide:
- Same dayYou will usually go home on the day of surgery, using crutches.
- 1 to 2 weeksMost people with a desk-based job are able to return to work.
- 2 weeksYour wound is checked at your first follow-up appointment. Physiotherapy starts after this visit.
- 6 weeksThe limits on weight bearing and bending usually ease, and you start to come off crutches.
- 8 weeksDr Vishal Pai expects you to be walking without crutches. Your knee should straighten fully and bend beyond 90 degrees.
- 4 monthsDr Vishal Pai expects your knee to have its full range of movement, with only a little swelling. You can return to deep squatting.
- 4 to 6 monthsYou may return to sport, depending on the nature of your repair.
What results can you expect?
A root repair aims to restore the function of the meniscus and slow wear in the knee. It does not reverse arthritis that is already there. Across studies, pain and function scores improve for most people after repair. [4]
Arthritis can still progress after a repair. About 1 in 10 people needed a knee replacement 5 to 10 years after repair, compared with about 1 in 3 after the torn part of the meniscus was removed (meniscectomy). [5]
What are the risks and complications?
Every operation carries risks, and Dr Vishal Pai goes through them with you before you decide. The main risks of meniscal root repair are:
- Repair failure. The root may not heal or the stitches may give way in about 15 in 100 people, and further surgery may be needed. [6]
- Arthritis progression. Wear in the knee can continue despite a repair, and some people later need a knee replacement. [4]
- Infection of the wound or the knee joint.
- Blood clots in the leg (deep vein thrombosis), which rarely travel to the lungs.
- Numbness around the small cuts or on the inner side of the leg, from injury to small skin nerves. This may be permanent.
- Irritation from the anchor holding the stitches in the bone, which occasionally needs a further procedure to remove it.
Rarely, a nerve or blood vessel at the back of the knee is injured. A nerve injury can cause foot drop (weakness lifting the foot). A small number of people have ongoing pain, swelling or stiffness, which may need a further arthroscopy. Heart attack, stroke and death are rare. You will receive a written information sheet with the full list of risks.
Where does Dr Vishal Pai consult and operate?
Dr Vishal Pai consults at Sandringham Orthopaedic Specialists, Suite 1, 60 Bay Road, Sandringham. He performs meniscal root repairs at Calvary Holmesglen Private Hospital, 490 South Road, Moorabbin, and The Avenue Hospital, 40 The Avenue, Windsor. Patients come from across Bayside, Glen Eira and the Mornington Peninsula, and some travel from regional Victoria.
References
Show all 7 referencesHide references
- Allaire R et al. 2008. Biomechanical consequences of a tear of the posterior root of the medial meniscus. Similar to total meniscectomy. The Journal of Bone and Joint Surgery (American Volume).
- Moon HK et al. 2012. Prognostic factors of arthroscopic pull-out repair for a posterior root tear of the medial meniscus. The American Journal of Sports Medicine.
- Dzidzishvili L et al. 2026. Combined high tibial osteotomy and medial meniscus posterior root repair may improve root healing without consistent reduction in meniscal extrusion or osteoarthritis progression: a systematic review. Arthroscopy.
- Chang PS et al. 2021. Midterm outcomes of posterior medial meniscus root tear repair: a systematic review. The American Journal of Sports Medicine.
- Krivicich LM et al. 2021. Comparison of long-term radiographic outcomes and rate and time for conversion to total knee arthroplasty between repair and meniscectomy for medial meniscus posterior root tears: a systematic review and meta-analysis. The American Journal of Sports Medicine.
- Dzidzishvili L et al. 2024. Lateral meniscus posterior root repairs show superior healing, reduced meniscal extrusion and improved clinical outcomes compared to medial meniscus posterior root repairs: a systematic review. Knee Surgery, Sports Traumatology, Arthroscopy.
- Krych AJ et al. 2023. Nonoperative management of degenerative medial meniscus posterior root tears: poor outcomes at a minimum 10-year follow-up. The American Journal of Sports Medicine.
Frequently asked questions
Do all meniscal root tears need surgery?
No. Not every root tear behaves the same way, and not every person benefits from surgery.
The decision depends on:
- The condition of your cartilage
- The alignment of your knee
- How far your meniscus has shifted out of place (extrusion)
- Your symptoms and activity goals.
It is worth having your knee assessed before you choose a treatment path, whether or not it includes surgery.
Is a root tear the same as a degenerative meniscal tear?
No. Most meniscal tears in middle-aged and older knees are degenerative tears, caused by gradual wear. These are usually treated with physiotherapy first.
A root tear is a specific tear where the meniscus comes away from its anchor on the bone. It can happen in an injury or through wear, but either way it changes how the whole meniscus carries load, which is why it is assessed differently. Read more about the different types of meniscus tear.
What does a root tear feel like?
Symptoms can be sudden, and some people describe difficulty walking after a root tear.
Most people describe:
- Pain on the inside or back of the knee
- Swelling
- Difficulty with squatting or stairs
- A knee that is simply not improving.
Locking is less common than with other types of meniscal tear.
What happens if a root tear is left untreated?
In some cases, symptoms can be managed without surgery. However, untreated root tears are associated with:
- Ongoing meniscus extrusion
- Increased pressure in the joint
- Progressive cartilage damage and arthritis over time.
In one long-term study of root tears treated without surgery, about half the people had a knee replacement within about 14 years. [7]
This is why the decision is less about the tear itself, and more about what it means for the future of the joint.
Can a root tear happen with an ACL injury?
Yes. Tears of the outer (lateral) meniscus root are associated with ACL tears and can be difficult to see on MRI. A root repair is usually performed at the same time as the ACL reconstruction. Read more about lateral meniscal root tears and the ACL.
When should I seek help after surgery?
Contact Dr Vishal Pai’s rooms or your GP, or go to your nearest emergency department, if you notice:
- Increasing swelling, redness or warmth around the knee
- A temperature above 38°C for 12 hours or more
- Fluid draining from the wound more than 72 hours after surgery
- Pain in your calf
- Chest pain or shortness of breath.
Next step
Talk through your options
If you are weighing up a meniscal root repair, Dr Vishal Pai can examine your knee, review your scans and explain all your options, including treatment without surgery.