30 seconds of Therapy: Meniscal Root Tears

May 21

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Meniscal Root Tear is clinically defined as either a complete avulsion of the meniscus from its tibial attachment, or a radial tear (tear that runs across the meniscus) located within 1 centimeter of the root attachment. These tears are significant because they can affect the biomechanics of the knee and lead to increased stress on the joint, potentially accelerating cartilage damage and osteoarthritis. — **Meniscal Root Tear** is clinically defined as either a complete avulsion of the meniscus from its tibial attachment, or a radial tear (tear that runs across the meniscus) located within 1 centimeter of the root attachment. These tears are significant because they can affect the biomechanics of the knee and lead to increased stress on the joint, potentially accelerating cartilage damage and osteoarthritis.

START

Recognizing Root Tears as Insertional Injuries
1. Meniscal root tears occur where the meniscus attaches to the tibia, often in the posterior horn. This leads to loss of hoop tension and higher joint loading.
2. If a patient presents with pain during squatting and has imaging confirming a posterior root tear, begin with non-weight-bearing mobility work such as supine heel slides within a limited ROM (0–90°).
Follow Surgical Protocols carefully
1. Root repair protocols are strict due to risk of re-tear.
  1. Non-weight-bearing (NWB) for the first 6 weeks
  2. Passive ROM from 0° to 90° of knee flexion during this phase
  3. Avoid active hamstring activation
  4. Example Exercise: (Heal Prop) Passive knee extension using a towel roll under the ankle with no active engagement from the hamstrings.
Monitoring Articular Load

Avoid exercises that increase compression or shear early on. particularly during the first 6 weeks.
Begin with open-chain quadriceps isometrics in 60° knee flexion while seated, holding for 5–10 seconds to build strength safely.

Download Exercise PDF

STOP

Active Flexion Early in Rehab
1. Active knee flexion recruits hamstrings and popliteus, which stress the repaired root. Avoid knee flexion for the first 0-6 weeks.
2. Use Passive-assisted ROM to 90° using a wall slide or clinician-assisted motion.
Progressing Weight-Bearing Too Quickly
1. Begin partial toe-touch weight-bearing with crutches around Week 4 only if the surgeon permits.
2. Progress to full weight bearing after 6 weeks with Physician Clearance only.
Assuming All Meniscal Tears Are the Same
1. Root tears require more caution and time than other meniscal tears.
2. Delay closed-chain exercises like mini-squats or leg presses until at least 4 months post-op.

WHY

Root Tears are Fragile?
1. Root Tears disables the meniscus’ ability to transmit loads and distribute joint forces, leading to increased contact pressure and early osteoarthritis—even when the rest of the meniscus appears intact.
Should PTs Get the Full Operative Report?
1. Understanding the exact location (e.g., posterior horn, root) and repair method allows tailored progression. For example, ramp or root repairs often require different ROM and strengthening constraints.

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