Knee

A meniscus root tear seen through the arthroscope, and how it is tied back

Hee Seung Nam, MD, Orthopedic Surgeon · October 30, 2026

In the previous article (If you heard a 'pop' on the stairs: meniscus root tear) I compared the 'root' of the meniscus to the iron hoop on a wooden barrel. Today I want to show arthroscopic pictures of a knee in which that hoop has broken. The images are part of the records of a patient I operated on, chosen so that no one can be identified.

The 'torn root' seen inside the knee

The rounded surface at the top of the arthroscopic screen is the end of the thighbone, and the bottom is the meniscus resting on the shinbone. Normally the back end of the meniscus should be firmly attached to the center of the shinbone, but in this knee that spot is empty and the end of the meniscus hangs ragged.

It can be diagnosed on MRI too, but seeing it with the arthroscope makes it immediately clear why people say the 'root has been pulled out.' In this state, when weight is applied the meniscus is pushed outward and cannot act as a cushion.

How is it tied back?

This patient did not have severe arthritis, so I performed a root repair to reattach the root to its original place. In brief, the method is as follows.

1. Clean up the damaged tissue at the end of the detached meniscus and at the bone site where it was originally attached.
2. Pass strong sutures through the end of the meniscus several times.
3. Drill a small tunnel from the front of the shinbone to the site of the original root.
4. Pull the sutures down through the tunnel to draw the end of the meniscus back into place, then tie them over a small metal button on the front of the shinbone to fix them.

After the repair is complete

When the sutures are pulled and fixed, the end of the meniscus is drawn into the empty spot and attached. It is as if the broken end of the hoop had been driven back into the barrel. Only then can the meniscus regain its ability to hold up when weight is applied (hoop tension).

But attaching it in the operating room is not the end. It takes time for the pulled-down root to actually settle into the bone. That is why for about a month after surgery I tell patients to use crutches without putting weight on the leg, and to avoid deep knee bending for several months. Half of the result of surgery depends on how well this period is respected.

Why I show the photographs

We often hear that “the meniscus is torn,” but it is hard to imagine what that looks like inside the knee. If you see the torn site and the repaired site directly, I think it will be a little easier to feel why you should not dismiss it as “a bit better,” and why the crutch period after surgery has to be kept.

Not every root tear can be repaired this way. If arthritis is far advanced or the legs are strongly bowed, I consider other treatments. The treatment choices are laid out in If you heard a 'pop' on the stairs: meniscus root tear.

This article is general medical information, and the surgical method and rehab schedule can vary with the condition of the knee and the hospital. If you have symptoms, please consult an orthopedic specialist. It contains surgical photographs.