Root repair

Root repair is a technique of repairing root tear, which is a serious injury of the posterior horn of meniscus. Due to gradual extrusion of the meniscus, patients with root tear are at risk of developing accelerated knee arthritis. Up to 30 % of patients with untreated root tear undergo a TKA implantation within 5 years. These are often the patients who do not fully recover after an arthroscopic debridement or after partial medial menisectomy, and keep complaining about pain in the joint space “with every single step”. Very often the underlying cause is an undiagnosed or untreated root tear.

Root tear is the equivalent of full radial tear. The meniscus cannot withstand axial load during walking. It is a similar situation as if you have a barrel fastened with hoops and one of those hoops bursts. If you keep filling the barrel, it will burst too. However, root tear has one great advantage compared to all the other radial ruptures. The root ties to an inclined plane on the back edge of the tibia, below the niveau of the cartilage, and outside the load zone. Here it is possible to repair it to its anatomical footprint, ideally by means of a transosseous technique. The success rate of a correctly technically delivered repair of a root tear exceeds 95 % and it means a massive improvement for the patients. They almost immediately get rid of the unpleasant pain in the popliteal region, quickly return to their normal performance, and are not at risk of developing degenerative changes.

Repairing a root tear is not difficult. The operating surgeon must know how to gain access to the posteromedial compartment by means of the MCL release technique. There is plenty of space laterally, it is even easier there. The surgeon must know the anatomy to prepare an anatomical footprint. The operating theatre must be equipped with a target tool to prepare the tunnels, and a tool for suturing the meniscus. And besides that you need just two suutres and one button. With our target tool that we are now getting ready for registration this technique becomes very simple and reproducible. The learning curve is pretty fast.