The anterior horn of the medial meniscus is attached to the tibial plateau anteriorly via strong meniscotibial fibres inserting in the intercondylar area of the tibia, anterior to the ACL tibial attachment. The anterior horn root is a broad fan-shaped attachment zone anterior and medial to the ACL tibial footprint. The transverse (intermeniscal) ligament connects the anterior horns of both menisci across the intercondylar area.
Anchors the anterior horn of the medial meniscus to the tibial plateau, preventing anterior displacement of the meniscal anterior horn; distributes anterior horn compressive loads to the tibia; contributes to meniscal hoop stress generation by fixing the horn.
Anterior horn root tears of the medial meniscus produce hoop stress failure: when the root attachment is disrupted the meniscus cannot generate compressive load transfer, allowing it to extrude medially and increasing medial compartment contact pressure. MRI demonstrates root attachment signal abnormality and increased medial meniscal extrusion beyond 3 mm. Root repair by transtibial pullout suture through a tibial tunnel to the root attachment restores hoop stress function. Anterior root tears are less common than posterior root tears but carry the same biomechanical significance.
Anterior root attachment tear disrupts the medial meniscus hoop stress mechanism allowing medial extrusion, identified on MRI as root signal abnormality and greater than 3 mm medial meniscal extrusion; pullout root repair through a tibial tunnel restoring the anterior horn attachment reduces extrusion and normalises medial compartment contact mechanics.
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