Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 23, Issue 1, pp 112–118 | Cite as

Different patterns of lateral meniscus root tears in ACL injuries: application of a differentiated classification system

  • Philipp Forkel
  • Sven Reuter
  • Frederike Sprenker
  • Andrea Achtnich
  • Elmar Herbst
  • Andreas Imhoff
  • Wolf Petersen



Posterior lateral meniscus root tears (PLMRTs) affect the intra-articular pressure distribution in the lateral compartment of the knee. The biomechanical consequences of these injuries are significantly influenced by the integrity of the meniscofemoral ligaments (MFLs). A newly introduced arthroscopic classification system for PLMRTs that takes MFL integrity into account has not yet been clinically applied but may be useful in selecting the optimal method of PLMRT repair.


Prospective ACL reconstruction data were collected. Concomitant injuries of the lateral meniscus posterior horn were classified according to their shape and MFL status. The classifications were: type 1, avulsion of the root; type 2, radial tear of the lateral meniscus posterior horn close to the root with an intact MFL; and type 3, complete detachment of the posterior meniscus horn.


Between January 2011 and May 2012, 228 consecutive ACL reconstructions were included. Lateral and medial meniscus tears were identified in 38.2 % (n = 87) and 44.7 % (n = 102), respectively. Of the 87 lateral meniscus tears, 32 cases had PLMRTs; the overall prevalence of PLMRTs was 14 % (n = 32). Two medial meniscus root tears were detected. All PLMRTs were classified according to the classification system described above, and the fixation procedure was adapted to the type of meniscus tear.


The PLMRT tear is a common injury among patients undergoing ACL repair and can be arthroscopically classified into three different types. Medial meniscus root tears are rare in association with ACL tears. The PLMRT classification presented here may help to estimate the injury’s impact on the lateral compartment and to identify the optimal treatment. These tears should not be overlooked, and the treatment strategy should be chosen with respect to the type of root tear.

Level of evidence



Meniscus root tear ACL tear Meniscofemoral ligaments Lateral meniscus classification Lateral quartet 


  1. 1.
    Ahn JH, Lee YS, Yoo JC, Chang MJ, Park SJ, Pae YR (2010) Results of arthroscopic all-inside repair for lateral meniscus root tear in patients undergoing concomitant anterior cruciate ligament reconstruction. Arthroscopy 26(1):67–75PubMedCrossRefGoogle Scholar
  2. 2.
    Allaire R, Muriuki M, Gilbertson L, Harner CD (2008) Biomechanical consequences of a tear of the posterior root of the medial meniscus. Similar to total meniscectomy. J Bone Joint Surg Am 90(9):1922–1931PubMedCrossRefGoogle Scholar
  3. 3.
    Amadi HO, Gupte CM, Lie DT, McDermott ID, Amis AA, Bull AM (2008) A biomechanical study of the meniscofemoral ligaments and their contribution to contact pressure reduction in the knee. Knee Surg Sports Traumatol Arthrosc 16(11):1004–1008PubMedCrossRefGoogle Scholar
  4. 4.
    Bao HR, Zhu D, Gong H, Gu GS (2013) The effect of complete radial lateral meniscus posterior root tear on the knee contact mechanics: a finite element analysis. J Orthop Sci 18(2):256–263PubMedCrossRefGoogle Scholar
  5. 5.
    Brody JM, Lin HM, Hulstyn MJ, Tung GA (2006) Lateral meniscus root tear and meniscus extrusion with anterior cruciate ligament tear. Radiology 239(3):805–810PubMedCrossRefGoogle Scholar
  6. 6.
    De Smet AA, Blankenbaker DG, Kijowski R, Graf BK, Shinki K (2009) MR diagnosis of posterior root tears of the lateral meniscus using arthroscopy as the reference standard. Am J Roentgenol 192(2):480–486CrossRefGoogle Scholar
  7. 7.
    Feucht MJ, Bigdon S, Mehl J, Bode G, Muller-Lantzsch C, Sudkamp NP, Niemeyer P (2014) Risk factors for posterior lateral meniscus root tears in anterior cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-014-3280-2 Google Scholar
  8. 8.
    Feucht MJ, Grande E, Brunhuber J, Rosenstiel N, Burgkart R, Imhoff AB, Braun S (2014) Biomechanical comparison between suture anchor and transtibial pull-out repair for posterior medial meniscus root tears. Am J Sports Med 42(1):187–193PubMedCrossRefGoogle Scholar
  9. 9.
    Forkel P, Herbort M, Schulze M, Rosenbaum D, Kirstein L, Raschke M, Petersen W (2013) Biomechanical consequences of a posterior root tear of the lateral meniscus: stabilizing effect of the meniscofemoral ligament. Arch Orthop Trauma Surg 133(5):621–626PubMedCrossRefGoogle Scholar
  10. 10.
    Forkel P, Herbort M, Sprenker F, Metzlaff S, Raschke M, Petersen W (2014) The biomechanical effect of a lateral meniscus posterior root tear with and without damage to the meniscofemoral ligament: efficacy of different repair techniques. Arthroscopy. doi: 10.1016/j.arthro.2014.02.040 PubMedGoogle Scholar
  11. 11.
    Forkel P, Petersen W (2012) Posterior root tear fixation of the lateral meniscus combined with arthroscopic ACL double-bundle reconstruction: technical note of a transosseous fixation using the tibial PL tunnel. Arch Orthop Trauma Surg 132(3):387–391PubMedCrossRefGoogle Scholar
  12. 12.
    Forkel P, Petersen W (2014) Knee ligment injuries. In: H-J Oestern, et al (eds), Bone and joint injuries, European Manual of Medicine. doi: 10.1007/978-3-642-38388-5_24
  13. 13.
    Gupte CM, Smith A, McDermott ID, Bull AM, Thomas RD, Amis AA (2002) Meniscofemoral ligaments revisited. Anatomical study, age correlation and clinical implications. J Bone Joint Surg Br 84(6):846–851PubMedCrossRefGoogle Scholar
  14. 14.
    Herbst E, Hoser C, Tecklenburg K, Filipovic M, Dallapozza C, Herbort M, Fink C (2014) The lateral femoral notch sign following ACL injury: frequency, morphology and relation to meniscal injury and sports activity. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-014-3022-5 Google Scholar
  15. 15.
    Hwang BY, Kim SJ, Lee SW, Lee HE, Lee CK, Hunter DJ, Jung KA (2012) Risk factors for medial meniscus posterior root tear. Am J Sports Med 40(7):1606–1610PubMedCrossRefGoogle Scholar
  16. 16.
    Kim YJ, Kim JG, Chang SH, Shim JC, Kim SB, Lee MY (2010) Posterior root tear of the medial meniscus in multiple knee ligament injuries. Knee 17(5):324–328PubMedCrossRefGoogle Scholar
  17. 17.
    Koenig JH, Ranawat AS, Umans HR, Difelice GS (2009) Meniscal root tears: diagnosis and treatment. Arthroscopy 25(9):1025–1032PubMedCrossRefGoogle Scholar
  18. 18.
    Marzo JM, Gurske-DePerio J (2009) Effects of medial meniscus posterior horn avulsion and repair on tibiofemoral contact area and peak contact pressure with clinical implications. Am J Sports Med 37(1):124–129PubMedCrossRefGoogle Scholar
  19. 19.
    Musahl V, Citak M, O’Loughlin PF, Choi D, Bedi A, Pearle AD (2010) The effect of medial versus lateral meniscectomy on the stability of the anterior cruciate ligament-deficient knee. Am J Sports Med 38(8):1591–1597PubMedCrossRefGoogle Scholar
  20. 20.
    Ozkoc G, Circi E, Gonc U, Irgit K, Pourbagher A, Tandogan RN (2008) Radial tears in the root of the posterior horn of the medial meniscus. Knee Surg Sports Traumatol Arthrosc 16(9):849–854PubMedCrossRefGoogle Scholar
  21. 21.
    Petersen W, Forkel P, Achtnich A, Metzlaff S, Zantop T (2012) Injuries of the anterior cruciate ligament: from prevention to therapy. Orthopädische und Unfallchirurgische Praxis 6 (1)Google Scholar
  22. 22.
    Petersen W, Forkel P, Feucht MJ, Zantop T, Imhoff AB, Brucker PU (2014) Posterior root tear of the medial and lateral meniscus. Arch Orthop Trauma Surg 134(2):237–255PubMedCrossRefGoogle Scholar
  23. 23.
    Petrigliano FA, Musahl V, Suero EM, Citak M, Pearle AD (2011) Effect of meniscal loss on knee stability after single-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 19(Suppl 1):S86–S93PubMedCrossRefGoogle Scholar
  24. 24.
    Pula DA, Femia RE, Marzo JM, Bisson LJ (2014) Are root avulsions of the lateral meniscus associated with extrusion at the time of acute anterior cruciate ligament injury? A case control study. Am J Sports Med 42(1):173–176PubMedCrossRefGoogle Scholar
  25. 25.
    Schillhammer CK, Werner FW, Scuderi MG, Cannizzaro JP (2012) Repair of lateral meniscus posterior horn detachment lesions: a biomechanical evaluation. Am J Sports Med 40(11):2604–2609PubMedCrossRefGoogle Scholar
  26. 26.
    Shelbourne KD, Roberson TA, Gray T (2011) Long-term evaluation of posterior lateral meniscus root tears left in situ at the time of anterior cruciate ligament reconstruction. Am J Sports Med 39(7):1439–1443PubMedCrossRefGoogle Scholar
  27. 27.
    Starke C, Kopf S, Grobel KH, Becker R (2010) The effect of a nonanatomic repair of the meniscal horn attachment on meniscal tension: a biomechanical study. Arthroscopy 26(3):358–365PubMedCrossRefGoogle Scholar
  28. 28.
    West RV, Kim JG, Armfield D, Harner CD (2004) Lateral meniscal root tears associated with anterior cruciate ligament injury: classification and management (SS-70). Arthroscopy 20:e32–e33CrossRefGoogle Scholar
  29. 29.
    Wilson BF, Johnson DL (2011) Posterior horn medial meniscal root repair with cruciate ligament/medial collateral ligament combined injuries. Orthopedics 34(12):986–988PubMedCrossRefGoogle Scholar
  30. 30.
    Yamamoto M, Hirohata K (1991) Anatomical study on the menisco-femoral ligaments of the knee. Kobe J Med Sci 37(4–5):209–226PubMedGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2014

Authors and Affiliations

  • Philipp Forkel
    • 1
  • Sven Reuter
    • 1
  • Frederike Sprenker
    • 2
  • Andrea Achtnich
    • 1
  • Elmar Herbst
    • 1
  • Andreas Imhoff
    • 1
  • Wolf Petersen
    • 2
  1. 1.Abteilung für Sportorthopädie, Klinikum rechts der IsarTU MünchenMunichGermany
  2. 2.Klinik für Orthopädie und UnfallchirurgieMartin-Luther-KrankenhausBerlinGermany

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