Treatment of Meniscus Root Tears

Root avulsion of the meniscus is a serious injury where the attachment of the meniscus to the tibia is torn. This can lead to significant knee instability, pain, and degenerative changes such as early osteoarthritis if not treated properly. Here are the treatment options for root avulsion of the meniscus:

Non-Surgical Treatment

Non-surgical treatment is typically reserved for patients who are not good surgical candidates or have low physical demands.

1. Rest

   • Avoid activities that put stress on the knee, such as running, jumping, and squatting.

2. Physical Therapy

   • Focuses on strengthening the muscles around the knee, improving range of motion, and stabilizing the joint. However, it does not address the underlying problem of the detached meniscus root.

3. Bracing

   • Knee braces can provide additional support and stability.

4. Pain Management

   • NSAIDs (non-steroidal anti-inflammatory drugs) can help manage pain and inflammation.

Surgical Treatment

Surgical intervention is often recommended for active individuals and those with significant symptoms or knee instability.

1. Meniscus Root Repair

   • The goal is to reattach the torn meniscus root to its original position on the tibia. This is usually performed arthroscopically.

   Procedure:

   • Arthroscopic Surgery: Small incisions are made, and a camera (arthroscope) is inserted to visualize the inside of the knee.
   • Debridement: Any damaged or loose meniscus tissue is trimmed.
   • Reattachment: Sutures are used to anchor the meniscus root back to the bone. Techniques include suture anchors or transtibial pull-out sutures that secure the meniscus to the tibial bone.

2. Meniscectomy (Partial)

   • In some cases where the meniscus cannot be repaired, a partial meniscectomy (removal of the damaged part of the meniscus) may be performed. However, this is less desirable as it can lead to decreased knee stability and increased risk of osteoarthritis.

Post-Surgical Rehabilitation

Rehabilitation is crucial for recovery and achieving the best outcomes.

1. Immediate Post-Surgery

   • Immobilization: A brace or splint may be used to immobilize the knee for a few weeks.
   • Weight-Bearing: Initially, weight-bearing is limited and gradually increased based on healing and surgeon’s instructions.

2. Physical Therapy

   • Phase 1: Focuses on reducing swelling, pain control, and gentle range of motion exercises.
   • Phase 2: Gradual introduction of weight-bearing exercises, strengthening of quadriceps and hamstrings, and improving knee stability.
   • Phase 3: Advanced strengthening, balance exercises, and return to sport-specific activities.

3. Return to Activity

   • Full return to sports or high-demand activities typically takes several months, depending on the extent of the injury and the success of rehabilitation.

Long-Term Outlook

Successful meniscus root repair can restore knee function and prevent further degenerative changes. However, factors such as patient age, activity level, and extent of the injury play a significant role in the overall prognosis.

Summary

Meniscus root avulsion is a serious knee injury that often requires surgical repair to restore knee function and prevent long-term complications. Non-surgical options may be considered for patients with low activity levels or those who are not candidates for surgery. Post-surgical rehabilitation is critical for achieving the best outcomes and returning to normal activities. Always consult with an orthopedic surgeon for an accurate diagnosis and appropriate treatment plan based on individual circumstances.

Author

Dr. Catherine Logan, MD, MBA Catherine Logan, MD, MBA, MSPT, is a sports medicine orthopaedic surgeon specializing in complex knee and shoulder surgery at Colorado Sports Medicine and Orthopaedics (COSMO) in Denver, Colorado. As a former physical therapist & trainer, Dr. Logan provides a distinct expertise in sports injury, prevention, and surgical management.