The posterior horn of the medial meniscus has the most robust tibial attachment of any meniscal horn, at the posterior intercondylar fossa just anterior to the PCL. The posterior root is mechanically critical.
Provides the critical posterior anchor resisting posterior horn extrusion during compressive loading and maintaining meniscal ring hoop stress.
Posterior medial root tears are biomechanically equivalent to total meniscectomy — the ring mechanism fails producing extrusion and rapid cartilage loss. Urgent transtibial root repair is the standard of care.
Complete root avulsion producing meniscal extrusion and medial compartment cartilage loss, requiring urgent transtibial root repair.
Extrusion beyond the tibial rim after root tear indicating loss of hoop stress function and predicting rapid medial arthritis.
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