Meniscal root tears: Significance, diagnosis, and treatment

American Journal of Sports Medicine

Volumn 42, Issue 12, 2014, Pages 3016-3030

  Bhatia, Sanjeev ^a   Laprade, Christopher M ^b   Ellman, Michael B ^b,c   Laprade, Robert F ^b,c  

^a RUSH MEDICAL COLLEGE   (United States)

^b STEADMAN PHILIPPON RESEARCH INSTITUTE   (United States)

^c THE STEADMAN CLINIC   (United States)

Author keywords

anterior root; lateral meniscus; medial meniscus; meniscal repair; meniscal tear; meniscus; meniscus root; posterior root

Indexed keywords

ALGORITHM; ANATOMY AND HISTOLOGY; ARTHROSCOPY; BIOMECHANICS; DECISION MAKING; HUMAN; INJURIES; KNEE INJURIES; KNEE MENISCUS; MALE; NUCLEAR MAGNETIC RESONANCE IMAGING; OUTCOME ASSESSMENT; PHYSICAL EXAMINATION; POSTOPERATIVE CARE; POSTOPERATIVE COMPLICATION; SUTURE ANCHOR; SUTURING METHOD;

ALGORITHMS; ARTHROSCOPY; BIOMECHANICAL PHENOMENA; DECISION MAKING; HUMANS; KNEE INJURIES; MAGNETIC RESONANCE IMAGING; MALE; MENISCI, TIBIAL; PATIENT OUTCOME ASSESSMENT; PHYSICAL EXAMINATION; POSTOPERATIVE CARE; POSTOPERATIVE COMPLICATIONS; SUTURE ANCHORS; SUTURE TECHNIQUES;

EID: 84913552137     PISSN: 03635465     EISSN: 15523365     Source Type: Journal    
DOI: 10.1177/0363546514524162     Document Type: Article

References (75)

1. Ahn JH, Lee YS, Yoo JC, Chang MJ, Park SJ, Pae YR. Results of arthroscopic all-inside repair for lateral meniscus root tear in patients undergoing concomitant anterior cruciate ligament reconstruction. Arthroscopy. 2010 ; 26 (1). 67-75
2. Ahn JH, Wang JH, Lim HC, et al. Double transosseous pull out suture technique for transection of posterior horn of medial meniscus. Arch Orthop Trauma Surg. 2009 ; 129 (3). 387-392
3. Ahn JH, Wang JH, Yoo JC, Noh HK, Park JH. A pull out suture for transection of the posterior horn of the medial meniscus: using a posterior trans-septal portal. Knee Surg Sports Traumatol Arthrosc. 2007 ; 15 (12). 1510-1513
4. Allaire R, Muriuki M, Gilbertson L, Harner CD. Biomechanical consequences of a tear of the posterior root of the medial meniscus: similar to total meniscectomy. J Bone Joint Surg Am. 2008 ; 90 (9). 1922-1931
5. Anderson CJ, Ziegler CG, Wijdicks CA, Engebretsen L, LaPrade RF. Arthroscopically pertinent anatomy of the anterolateral and posteromedial bundles of the posterior cruciate ligament. J Bone Joint Surg Am. 2012 ; 94 (21). 1936-1945
6. Beldame J, Wajfisz A, Lespagnol F, Hulet C, Seil R. Lateral meniscus lesions on unstable knee. Orthop Traumatol Surg Res. 2009 ; 95 (8). S65 - S69
7. Berlet GC, Fowler PJ. The anterior horn of the medical meniscus: an anatomic study of its insertion. Am J Sports Med. 1998 ; 26 (4). 540-543
8. Bhatia S, Korth K, Van Thiel GS, et al. Effect of reamer design on posteriorization of the tibial tunnel during endoscopic transtibial anterior cruciate ligament reconstruction. Am J Sports Med. 2013 ; 41 (6). 1282-1289
9. Bin SI, Kim JM, Shin SJ. Radial tears of the posterior horn of the medial meniscus. Arthroscopy. 2004 ; 20 (4). 373-378
10. Brody JM, Lin HM, Hulstyn MJ, Tung GA. Lateral meniscus root tear and meniscus extrusion with anterior cruciate ligament tear. Radiology. 2006 ; 239 (3). 805-810
11. Choi CJ, Choi YJ, Lee JJ, Choi CH. Magnetic resonance imaging evidence of meniscal extrusion in medial meniscus posterior root tear. Arthroscopy. 2010 ; 26 (12). 1602-1606
12. Choi SH, Bae S, Ji SK, Chang MJ. The MRI findings of meniscal root tear of the medial meniscus: emphasis on coronal, sagittal and axial images. Knee Surg Sports Traumatol Arthrosc. 2012 ; 20 (10). 2098-2103
13. Costa CR, Morrison WB, Carrino JA. Medial meniscus extrusion on knee MRI: is extent associated with severity of degeneration or type of tear?. AJR Am J Roentgenol. 2004 ; 183 (1). 17-23
14. De Smet AA, Blankenbaker DG, Kijowski R, Graf BK, Shinki K. MR diagnosis of posterior root tears of the lateral meniscus using arthroscopy as the reference standard. AJR Am J Roentgenol. 2009 ; 192 (2). 480-486
15. Engelsohn E, Umans H, Difelice GS. Marginal fractures of the medial tibial plateau: possible association with medial meniscal root tear. Skeletal Radiol. 2007 ; 36 (1). 73-76
16. Feucht MJ, Minzlaff P, Saier T, Lenich A, Imhoff AB, Hinterwimmer S. Avulsion of the anterior medial meniscus root: case report and surgical technique. Knee Surg Sports Traumatol Arthrosc. :
17. Fithian DC, Kelly MA, Mow VC. Material properties and structure-function relationships in the menisci. Clin Orthop Relat Res. 1990 ; 252: 19-31
18. Fox AJ, Bedi A, Rodeo SA. The basic science of human knee menisci: structure, composition, and function. Sports Health. 2012 ; 4 (4). 340-351
19. Fox MG. MR imaging of the meniscus: review, current trends, and clinical implications. Radiol Clin North Am. 2007 ; 45 (6). 1033 vii - 1053
20. Griffith CJ, LaPrade RF, Fritts HM, Morgan PM. Posterior root avulsion fracture of the medial meniscus in an adolescent female patient with surgical reattachment. Am J Sports Med. 2008 ; 36 (4). 789-792
21. Harner CD, Mauro CS, Lesniak BP, Romanowski JR. Biomechanical consequences of a tear of the posterior root of the medial meniscus: surgical technique. J Bone Joint Surg Am. 2009 ; 91: 257-270
22. Harper KW, Helms CA, Lambert HS, Higgins LD. Radial meniscal tears: significance, incidence, and MR appearance. AJR Am J Roentgenol. 2005 ; 185 (6). 1429-1434
23. Hein CN, Deperio JG, Ehrensberger MT, Marzo JM. Effects of medial meniscal posterior horn avulsion and repair on meniscal displacement. Knee. 2011 ; 18 (3). 189-192
24. Hwang BY, Kim SJ, Lee SW, et al. Risk factors for medial meniscus posterior root tear. Am J Sports Med. 2012 ; 40 (7). 1606-1610
25. Johannsen AM, Civitarese DM, Padalecki JR, Goldsmith MT, Wijdicks CA, LaPrade RF. Qualitative and quantitative anatomic analysis of the posterior root attachments of the medial and lateral menisci. Am J Sports Med. 2012 ; 40 (10). 2342-2347
26. Johnson DL, Swenson TM, Livesay GA, Aizawa H, Fu FH, Harner CD. Insertion-site anatomy of the human menisci: gross, arthroscopic, and topographical anatomy as a basis for meniscal transplantation. Arthroscopy. 1995 ; 11 (4). 386-394
27. Jones AO, Houang MT, Low RS, Wood DG. Medial meniscus posterior root attachment injury and degeneration: MRI findings. Australas Radiol. 2006 ; 50 (4). 306-313
28. Jung YH, Choi NH, Oh JS, Victoroff BN. All-inside repair for a root tear of the medial meniscus using a suture anchor. Am J Sports Med. 2012 ; 40 (6). 1406-1411
29. Kidron A, Thein R. Radial tears associated with cleavage tears of the medial meniscus in athletes. Arthroscopy. 2002 ; 18 (3). 254-256
30. Kim JG, Lee YS, Bae TS, et al. Tibiofemoral contact mechanics following posterior root of medial meniscus tear, repair, meniscectomy, and allograft transplantation. Knee Surg Sports Traumatol Arthrosc. 2013 ; 21 (9). 2121-2125
31. Kim JH, Chung JH, Lee DH, Lee YS, Kim JR, Ryu KJ. Arthroscopic suture anchor repair versus pullout suture repair in posterior root tear of the medial meniscus: a prospective comparison study. Arthroscopy. 2011 ; 27 (12). 1644-1653
32. Kim SB, Ha JK, Lee SW, et al. Medial meniscus root tear refixation: comparison of clinical, radiologic, and arthroscopic findings with medial meniscectomy. Arthroscopy. 2011 ; 27 (3). 346-354
33. Kim YJ, Kim JG, Chang SH, Shim JC, Kim SB, Lee MY. Posterior root tear of the medial meniscus in multiple knee ligament injuries. Knee. 2010 ; 17 (5). 324-328
34. Kim YM, Rhee KJ, Lee JK, Hwang DS, Yang JY, Kim SJ. Arthroscopic pullout repair of a complete radial tear of the tibial attachment site of the medial meniscus posterior horn. Arthroscopy. 2006 ; 22 795 (7). e791-794
35. Koenig JH, Ranawat AS, Umans HR, Difelice GS. Meniscal root tears: diagnosis and treatment. Arthroscopy. 2009 ; 25 (9). 1025-1032
36. Kohn D, Moreno B. Meniscus insertion anatomy as a basis for meniscus replacement: a morphological cadaveric study. Arthroscopy. 1995 ; 11 (1). 96-103
37. Kopf S, Colvin AC, Muriuki M, Zhang X, Harner CD. Meniscal root suturing techniques: implications for root fixation. Am J Sports Med. 2011 ; 39 (10). 2141-2146
38. LaPrade CM, Jansson KS, Dorman G, Smith SD, Wijdicks CA, LaPrade RF. Altered tibiofemoral contact mechanics due to lateral meniscus posterior horn root avulsions and radial tears can be restored with in situ pull out repairs. J Bone Joint Surg. 2014 ; 96 (6). 471-479
39. Lee DH, Lee BS, Kim JM, et al. Predictors of degenerative medial meniscus extrusion: radial component and knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2011 ; 19 (2). 222-229
40. Lee JH, Lim YJ, Kim KB, Kim KH, Song JH. Arthroscopic pullout suture repair of posterior root tear of the medial meniscus: radiographic and clinical results with a 2-year follow-up. Arthroscopy. 2009 ; 25 (9). 951-958
41. Lee SY, Jee WH, Kim JM. Radial tear of the medial meniscal root: reliability and accuracy of MRI for diagnosis. AJR Am J Roentgenol. 2008 ; 191 (1). 81-85
42. Lerer DB, Umans HR, Hu MX, Jones MH. The role of meniscal root pathology and radial meniscal tear in medial meniscal extrusion. Skeletal Radiol. 2004 ; 33 (10). 569-574
43. Levy IM, Torzilli PA, Warren RF. The effect of medial meniscectomy on anterior-posterior motion of the knee. J Bone Joint Surg Am. 1982 ; 64 (6). 883-888
44. Magee T. MR findings of meniscal extrusion correlated with arthroscopy. J Magn Reson Imaging. 2008 ; 28 (2). 466-470
45. Marzo JM, Gurske-DePerio J. Effects of medial meniscus posterior horn avulsion and repair on tibiofemoral contact area and peak contact pressure with clinical implications. Am J Sports Med. 2009 ; 37 (1). 124-129
46. Marzo JM, Kumar BA. Primary repair of medial meniscal avulsions: 2 case studies. Am J Sports Med. 2007 ; 35 (8). 1380-1383
47. Navarro-Holgado P, Cuevas-Perez A, Aguayo-Galeote MA, Carpintero-Benitez P. Anterior medial meniscus detachment and anterior cruciate ligament tear. Knee Surg Sports Traumatol Arthrosc. 2007 ; 15 (5). 587-590
48. Nelson EW, LaPrade RF. The anterior intermeniscal ligament of the knee: an anatomic study. Am J Sports Med. 2000 ; 28 (1). 74-76
49. Nicholas SJ, Golant A, Schachter AK, Lee SJ. A new surgical technique for arthroscopic repair of the meniscus root tear. Knee Surg Sports Traumatol Arthrosc. 2009 ; 17 (12). 1433-1436
50. Nikolic DK. Lateral meniscal tears and their evolution in acute injuries of the anterior cruciate ligament of the knee: arthroscopic analysis. Knee Surg Sports Traumatol Arthrosc. 1998 ; 6 (1). 26-30
51. Ohkoshi Y, Takeuchi T, Inoue C, Hashimoto T, Shigenobu K, Yamane S. Arthroscopic studies of variants of the anterior horn of the medical meniscus. Arthroscopy. 1997 ; 13 (6). 725-730
52. Ozkoc G, Circi E, Gonc U, Irgit K, Pourbagher A, Tandogan RN. Radial tears in the root of the posterior horn of the medial meniscus. Knee Surg Sports Traumatol Arthrosc. 2008 ; 16 (9). 849-854
53. Paci JM, Scuderi MG, Werner FW, Sutton LG, Rosenbaum PF, Cannizzaro JP. Knee medial compartment contact pressure increases with release of the type I anterior intermeniscal ligament. Am J Sports Med. 2009 ; 37 (7). 1412-1416
54. Padalecki JR, Jansson KS, Smith SD, et al. Biomechanical consequences of a complete radial tear adjacent to the medial meniscus posterior root attachment site: in-situ pullout repair restores derangement of joint mechanics. Am J Sports Med. 2014 ; 42 (3). 699-707
55. Pagnani MJ, Cooper DE, Warren RF. Extrusion of the medial meniscus. Arthroscopy. 1991 ; 7 (3). 297-300
56. Papalia R, Vasta S, Franceschi F, D'Adamio S, Maffulli N, Denaro V. Meniscal root tears: from basic science to ultimate surgery. Br Med Bull. 2013 ; 106: 91-115
57. Poh SY, Yew KS, Wong PL, et al. Role of the anterior intermeniscal ligament in tibiofemoral contact mechanics during axial joint loading. Knee. 2012 ; 19 (2). 135-139
58. Raustol OA, Poelstra KA, Chhabra A, Diduch DR. The meniscal ossicle revisited: etiology and an arthroscopic technique for treatment. Arthroscopy. 2006 ; 22 (6). 687.e1-687.e3
59. Rosslenbroich SB, Borgmann J, Herbort M, Raschke MJ, Petersen W, Zantop T. Root tear of the meniscus: biomechanical evaluation of an arthroscopic refixation technique. Arch Orthop Trauma Surg. 2013 ; 133 (1). 111-115
60. Schillhammer CK, Werner FW, Scuderi MG, Cannizzaro JP. Repair of lateral meniscus posterior horn detachment lesions: a biomechanical evaluation. Am J Sports Med. 2012 ; 40 (11). 2604-2609
61. Seil R, Duck K, Pape D. A clinical sign to detect root avulsions of the posterior horn of the medial meniscus. Knee Surg Sports Traumatol Arthrosc. 2011 ; 19 (12). 2072-2075
62. Seo JH, Li G, Shetty GM, et al. Effect of repair of radial tears at the root of the posterior horn of the medial meniscus with the pullout suture technique: a biomechanical study using porcine knees. Arthroscopy. 2009 ; 25 (11). 1281-1287
63. Shelbourne KD, Roberson TA, Gray T. Long-term evaluation of posterior lateral meniscus root tears left in situ at the time of anterior cruciate ligament reconstruction. Am J Sports Med. 2011 ; 39 (7). 1439-1443
64. Shepard MF, Hunter DM, Davies MR, Shapiro MS, Seeger LL. The clinical significance of anterior horn meniscal tears diagnosed on magnetic resonance images. Am J Sports Med. 2002 ; 30 (2). 189-192
65. Slauterbeck JR, Kousa P, Clifton BC, et al. Geographic mapping of meniscus and cartilage lesions associated with anterior cruciate ligament injuries. J Bone Joint Surg Am. 2009 ; 91 (9). 2094-2103
66. Smith JP, Barrett GR. Medial and lateral meniscal tear patterns in anterior cruciate ligament-deficient knees: a prospective analysis of 575 tears. Am J Sports Med. 2001 ; 29 (4). 415-419
67. Starke C, Kopf S, Grobel KH, Becker R. The effect of a nonanatomic repair of the meniscal horn attachment on meniscal tension: a biomechanical study. Arthroscopy. 2010 ; 26 (3). 358-365
68. Sung JH, Ha JK, Lee DW, Seo WY, Kim JG. Meniscal extrusion and spontaneous osteonecrosis with root tear of medial meniscus: comparison with horizontal tear. Arthroscopy. 2013 ; 29 (4). 726-732
69. Tandogan RN, Taser O, Kayaalp A, et al. Analysis of meniscal and chondral lesions accompanying anterior cruciate ligament tears: relationship with age, time from injury, and level of sport. Knee Surg Sports Traumatol Arthrosc. 2004 ; 12 (4). 262-270
70. Thompson WO, Thaete FL, Fu FH, Dye SF. Tibial meniscal dynamics using three-dimensional reconstruction of magnetic resonance images. Am J Sports Med. 1991 ; 19 (3). 210-215
71. Toy JO, Feeley BT, Gulotta LV, Warren RF. Arthroscopic avulsion repair of a pediatric ACL with an anomalous primary insertion into the lateral meniscus. HSS J. 2011 ; 7 (2). 190-193
72. Vyas D, Harner CD. Meniscus root repair. Sports Med Arthrosc Rev. 2012 ; 20 (2). 86-94
73. Walker PS, Erkman MJ. The role of the menisci in force transmission across the knee. Clin Orthop Relat Res. 1975 ; 109: 184-192
74. Zantop T, Wellmann M, Fu FH, Petersen W. Tunnel positioning of anteromedial and posterolateral bundles in anatomic anterior cruciate ligament reconstruction: anatomic and radiographic findings. Am J Sports Med. 2008 ; 36 (1). 65-72
75. Ziegler CG, Pietrini SD, Westerhaus BD, et al. Arthroscopically pertinent landmarks for tunnel positioning in single-bundle and double-bundle anterior cruciate ligament reconstructions. Am J Sports Med. 2011 ; 39 (4). 743-752