Steve Mora MD
Orange County Knee Specialist
ON THE TOPIC OF “ROOT” TEARS OF THE MENISCUS AND MORE: There is an unusual type of meniscus tear pattern which we call “root avulsion” or “root tears”. These tears occur in the back of the knee at the point where the meniscus attaches to the bone.
When these tears happen they usually lead to abrupt onset knee pain usually in the back of the knee.
They are difficult to identifying on an MRI unless you know what you are looking for.
They are tricky to diagnosis. As a surgeon you have to look for the tears to find them. It’s also not uncommon for the radiologist to also miss the tears. It’s only after many years of treating knee pain that I’ve discovered the importance of identifying these tears. When they are identified it’s usually best to repair them. Here’s why.
The repair is not like other meniscus tear repairs. It is actually a type of repair that requires the torn meniscus stump to be reattached to the bone. It takes extra time and special instruments and techniques.
1- Root tears are difficult to diagnose and often missed by the doctor and the radiologist.
2- The repair is not easy unless you have the experience.
3-A successful repair mitigate the onset of arthritis.
MRI image showing medial meniscus root tear.
Medial Meniscus Posterior Horn avulsion
Procedure:
I prepare the bony bed site by roughing up the area. Then I pass two sutures through the torn loose fragment locking in the sutures firmly. I pass 2 heavy nonabsorbable suture through the root tear.
I then focus on bony tunnel by passing 2.4 guide pin with help of an ACL guide. I increase tunnel diameter with a 4 mm canullated drill.
A Hewsen suture passer is used to pass into the tunnel. The previously placed sutures are passed into and out tunnel with the passer. Prior to passing sutures I mark the limbs so I know which limb to tie to which.
I tie over a simple inexpensive metal button. The trick is to pull on the 2 sutures which you’re not tying while you tie the other pair.
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