The posterior meniscal roots anchor the posterior horns of both menisci to the tibia. Posterior root tears, equivalent to a total meniscectomy in terms of load distribution failure, produce rapid medial compartment osteoarthritis progression. The medial posterior root is most commonly torn, producing the characteristic meniscal extrusion visible on MRI where the medial meniscus herniates beyond the tibial plateau margin.
| Origin | Posterior horns of the medial and lateral menisci |
|---|---|
| Insertion | Posterior intercondylar area of the tibia: the lateral root just behind the lateral intercondylar tubercle, the medial root behind the medial intercondylar tubercle and in front of the PCL attachment |
Anchor the back of each meniscus to the tibia so the meniscus keeps its hoop tension and spreads load across the joint
Medial posterior root tear presents as acute medial knee pain in middle-aged obese patients from a squatting or twisting movement. MRI shows the root avulsion with meniscal extrusion beyond 3 mm. The 'cleft sign' on coronal MRI (vertical cleft at the posterior root attachment) confirms the diagnosis. Transtibial pullout repair, threading sutures through the posterior horn and out a tibial bone tunnel, restores root function. Untreated root tears produce compartment arthritis within 2-3 years.
Medial meniscal posterior horn avulsion producing meniscal extrusion and rapid compartment arthritis progression managed with arthroscopic transtibial pullout repair.
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