What is meniscal root repair surgery?
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 attachment. A meniscal root tear is a specific type of meniscus injury where the attachment of the meniscus to the bone is disrupted.
This small attachment plays a critical role in how the knee handles load. When the root attachment is no longer intact, the meniscus stops functioning as it should. Most meniscal tears do not have this effect. A root tear is different.
Without a functioning root, the meniscus can no longer distribute load effectively. It shifts out of position, and the pressure through the joint increases significantly. In many ways, this behaves similarly to having the whole meniscus removed.
This is why these injuries are often associated with ongoing pain that does not settle and the early development of arthritis in the affected compartment. Meniscal root repair surgery aims to restore this attachment, preserving the function of the meniscus and protecting the joint over time.
What is involved in meniscal root repair surgery?
The aim of surgery is to restore the meniscus to its native attachment on the bone.
The steps involved in meniscal root repair surgery include:
1. Diagnostic arthroscopy
2-3 small (< 1 cm) portals are created to allow passage of a camera and surgical tools within the knee joint. The whole joint is inspected for damage. The diagnosis of a root tear is confirmed and the status of the cartilage within the knee is noted.
2. Meniscal root repair
This is most commonly performed using a transtibial pull-out technique. 2-3 luggage tag sutures are passed through the torn root attachment. A small bone tunnel is drilled through the tibia to the site of the root attachment within the knee. The root repair stitches are then passed through the tibial bone tunnel and secured into the tibia using a bone anchor or small anchoring plate. This allows the meniscus to heal back to the bone and aims to restore the function of the meniscus as a shock absorber.
Frequently Asked Questions
Do all meniscal root tears need surgery?
No. Not every root tear behaves the same way, and not every patient benefits from surgery.
The decision depends on:
- The condition of your cartilage
- The alignment of your knee
- The degree of your meniscus extrusion
- Your symptoms and activity goals
It is important to obtain a specialist opinion on your individual circumstances before choosing a non-surgical pathway.
When is surgery recommended?
Surgery is usually considered in the following situations:
- There is minimal or early arthritis
- The root tear is traumatic
- Symptoms are ongoing despite appropriate rehabilitation
- The goal is to preserve the joint long-term
Once the root is torn, the knee is exposed to higher contact pressures, which can accelerate the development of osteoarthritis if left untreated.
When is surgery less helpful?
Surgery may be less beneficial when there is already advanced arthritis. In these situations, repairing the root does not reliably reverse the underlying joint changes.
What does a root tear feel like?
Symptoms can be dramatic, and some patients describe sudden difficulty walking after they have sustained a root tear.
Most patients 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 in other types of meniscal tears.
Does meniscal root repair work?
Repair can improve pain and function, reduce progression of arthritis, and restore more normal knee biomechanics.
Earlier repair is generally associated with better outcomes, particularly before significant cartilage damage develops.
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 joint pressure
- Progressive cartilage damage and the development of osteoarthritis over time
This is why the decision is less about the tear itself, and more about what it means for the future of the joint.
What is the recovery following root repair surgery?
The recovery is more structured than for a simple meniscectomy. Post-operatively, there will be a 6-week period of non-weight-bearing on the affected knee. This means hopping around using crutches or a frame. During this period, deep bending within the knee is restricted. These restrictions facilitate an environment where the meniscus can heal back to the bone. Following this, rehabilitation is required to regain lower limb strength that has been affected during the period of non-weight-bearing.
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.