MENISCUS ROOT TEARS IN CHILDREN AND ADOLESCENTS

Background: The medial and lateral menisci function to optimize force transmission across the knee by increasing contact area between the femur and tibia, absorbing shock, and transmitting loads. Injuries to the meniscus root attachments result in extrusion of the meniscus, impaired distribution of hoop stresses, and degenerative articular wear. The purpose of this study is to describe meniscus root tears, associated injuries, and treatment in a series of pediatric patients Methods: A single-institution retrospective review was performed of consecutive pediatric patients treated for meniscus root tears from 2013 – 2017. Inclusion criteria were patients less than 19 years of age, arthroscopic evidence of a meniscus root tear, and minimum 6 months clinical follow-up. The primary outcome was surgery for revision of the meniscus repair. Results: Twenty-seven patients were identified to fit inclusion criteria. There were 15 males and 12 females with a mean age of 15.2 years (range 7 – 18 years). Basketball, soccer, and football accounted for the majority (56%) of injuries. The lateral meniscus was involved in 21 patients (78%) and the medial meniscus in 6 patients (22%). The posterior meniscus root was torn in 25 patients (93%) and anterior meniscus root in 2 patients (7%). The most common injury pattern was a lateral meniscus posterior root tear (19 patients, 70%). Associated injuries included an ACL tear (19 patients, 70%), PCL tear (6 patients, 22%), and a tear of the opposite meniscus (7 patients, 26%). Two root tears occurred in isolation, and both were of the posterior root of the medial meniscus. All patients were treated surgically with an arthroscopic transosseous root repair in addition to simultaneous treatment for their associated injuries. Mean follow-up was 14 months (range 6 – 37 months). No patients required additional surgery for their meniscus root tear. Two patients had a second surgery on the affected knee: one for revision ACL reconstruction 2 years following the primary procedure and the other for chondroplasty of the patella 2.5 years following the primary procedure. Conclusions: Meniscus root tears occur in pediatric and adolescent patients, most commonly affecting the posterior root of the lateral meniscus and occurring in association with ACL tears. The adolescent meniscus root injury pattern is unique compared to the adult population in which the medial meniscus posterior root is often injured in isolation. Inspection of the meniscus root attachments with deliberate probing to assess the meniscus roots should be a routine part of every knee arthroscopy. In our case series, transosseous root repair resulted in successful outcomes in all patients without need for any additional meniscus treatment.