The meniscus root, which is the tibial attachment of the anterior and posterior horns of the meniscus, is essential for avoiding meniscal extrusion under axial stresses. Meniscus root tears, including 15–20% of all meniscal tears, compromise hoop stress resistance, resulting in biomechanical alterations akin to total meniscectomy. The growing acknowledgement of these injuries has led to the identification of new morphologic patterns of root rips, necessitating an expanded classification system and innovative surgical treatment procedures to ensure secure fixation and maintain meniscal function. Lateral root tears are frequently connected with ACL injuries in young, active persons, but medial root tears are typically degenerative, related to osteoarthritis, and identified in up to 78% of total knee replacement patients. Untreated root tears expedite cartilage deterioration, highlighting the necessity for early detection, sophisticated categorisation, and novel treatment techniques to restore meniscal integrity and avert the advancement of osteoarthritis.