Episode 88: How to Manage Posterior Medial Meniscal Root Repair?

This week we discuss considerations when treating posterior medial meniscus root tears. Each meniscus has an anterior and posterior root, and a root tear is a radial tear within 1 cm of the attachment. Radial tears cut across the fibers of the meniscus disrupting the hoop stress mechanism: how the meniscus disperses load by expanding with axial load. Possibly due to this disruption, meniscal root tears are associated with accelerated osteoarthritis progression. Therefore, surgical repair, rather than meniscectomy, is typically advised, especially in younger patients with previously healthy knees since menisectomy has also recently been linked to more rapid OA progression. There are many post-operative considerations, including: minimizing joint load via a conservative progression from non-weight bearing for 6 weeks to a 4 week progression to full weight bearing, limiting knee flexion range of motion to 90 degrees for the first 2 weeks while aiming to achieve full extension as soon as possible, minimizing arthrogenic muscle inhibition, using caution with repetitive hamstring pulling into flexion, and waiting 9-10 weeks until initiating shallow squatting due to increases in posterior horn meniscal pressure, joint compressive forces, and joint shear from squatting.
The abstract can be found here: ijspt.org/post...
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