Medial meniscus root tears: mechanics, management, and techniques.

The medial meniscus posterior root (MMPR) provides biomechanical support to the medial compartment of the knee. An MMPR tear confers significantly increased peak contact pressures in the medial compartment. MMPR tears (MMPRTs), when unrecognized or when treated nonoperatively, often result in rapid progression of osteoarthritis. Once described as a silent epidemic, awareness of the clinical presentation and common imaging findings associated with MMPRTs has improved recognition of MMPRTs by orthopedic surgeons. The majority of patients with MMPRTs are candidates for repair of the MMPR whenever possible. In patients with early osteoarthritis, coronal knee malalignment, advanced age, or irreparable tear patterns, the indications for management are not well defined. Various techniques for repair for the repair of MMPR have been described, including the arthroscopic approach, suture configurations, and different implant properties. In addition to the repair of the MMPR, a novel technique aiming to centralize the meniscus can decrease meniscal extrusion, which is often not reliably addressed with MMPR repair alone. While MMPRTs remain a challenging injury for patients, increased recognition of these tears allows for improved decision-making regarding management of these injuries. Surgical management techniques continue to be refined and are aimed at restoring native anatomy of the medial meniscus to the extent possible, with the ultimate goal of prolonging the life of the native knee and facilitating a return to satisfactory function.