title: Meniscal root tears: a classification system based on tear morphology.
abstract: BACKGROUND
  Meniscal root tears present in many forms and can have profound consequences on the health of knee articular cartilage. While the biomechanics, natural history, and treatment of root tears have been increasingly investigated, the spectrum of meniscal root tear patterns observed during arthroscopic examination has yet to be defined and categorized.
  
  
  OBJECTIVE
  To establish a classification system for meniscal root tears by reporting the morphology of meniscal root tears from a consecutive series of arthroscopic surgeries. It was hypothesized that meniscal root tears could be grouped into types by distinct tear patterns and that recognition of tear pattern would affect treatment choice.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  All patients who underwent arthroscopic surgery from April 2010 to May 2014 by a single orthopaedic surgeon were included. After arthroscopic examination, data regarding the integrity of the meniscal roots were prospectively recorded in a data registry. Tear morphology and treatment received were subsequently extracted by 2 independent reviewers from operative notes and arthroscopic surgical photos.
  
  
  RESULTS
  A total of 71 meniscal root tears in 67 patients were grouped into tear types with similar tear morphologies. Meniscal root tear patterns were categorized into partial stable root tears (type 1; n = 5); complete radial tears within 9 mm of the bony root attachment (type 2; n = 48), further subclassified into types 2A, 2B, and 2C, located 0 to <3 mm, 3 to <6 mm, and 6 to 9 mm from the root attachment, respectively; bucket-handle tears with a complete root detachment (type 3; n = 4); complex oblique tears with complete root detachments extending into the root attachment (type 4; n = 7); and bony avulsion fractures of the root attachments (type 5; n = 7).
  
  
  CONCLUSIONS
  This study demonstrated that it was possible to establish a concise classification system to group patients with meniscal root tears by tear morphology. Treatments received varied across tear types.
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: LaPrade
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, USA.
authors.forename: Evan W
authors.initials: EW
authors.lastname: James
authors.affiliation: The Steadman Clinic, Vail, Colorado, USA.
authors.forename: Tyler R
authors.initials: TR
authors.lastname: Cram
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Feagin
authors.affiliation: University of Oslo, Oslo, Norway.
authors.forename: Lars
authors.initials: L
authors.lastname: Engebretsen
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, USA The Steadman Clinic, Vail, Colorado, USA drlaprade@sprivail.org.
authors.forename: Robert F
authors.initials: RF
authors.lastname: LaPrade
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001182:Arthroscopy; D002358:Cartilage, Articular / Q000293:injuries*; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000145:classification* / Q000473:pathology; D007719:Knee Joint / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012421:Rupture / Q000145:classification / Q000473:pathology / Q000601:surgery; D000070600:Tibial Meniscus Injuries; D055815:Young Adult
keywords: classification; meniscus root; meniscus root tear; radial tear