Arthroscopic Meniscal Root Repair Options

Menisci are fibrocartilaginous structures in the knee that assist in joint preservation by providing knee stability, shock absorption, and load transmission capabilities. Meniscus root integrity is essential to convert axial loading forces across the knee into circumferential hoop stresses. Meniscus root tears disrupt tibiofemoral contact mechanics by increasing meniscal extrusion and decreasing its intrinsic load sharing ability. Consequently, these injuries accelerate degenerative changes across the knee joint and have been described to be functionally and biomechanically equivalent to complete meniscectomy. Meniscus root tears can be managed nonoperatively or operatively, depending on the clinical presentation. Contemporary literature demonstrates reduced rates of osteoarthritis (OA) and decreased progression to arthroplasty following meniscus root repair when compared to partial meniscectomy and nonsurgical management. The transtibial pull-through repair technique is a biomechanically robust option that offers surgeons a safe and effective repair method with familiar arthroscopy portals. Arthroscopic centralization is an emerging area of interest and modern repair technique aimed at enhancing existing strategies by reducing postoperative meniscal extrusion. The purpose of this chapter is to describe meniscus root tears, the clinical significance of tears, and the authors’ preferred technique for arthroscopic meniscus root repair.