Anatomical predictors of medial meniscus posterior root tear

Introduction . In the context of an increased incidence of knee osteoarthritis, the identification of factors, contributing to the development of this pathology is of particular importance. Meniscal injury, including the injury of their roots, predisposes to the progression of osteoarthritis. In this regard, it is especially important to identify these factors.

Aim . To identify morphological features of the structural elements of the lower limb in the injury of the medial meniscus posterior root.

Materials and methods. The study included 100 patients (mean age: 50,5 years), who were divided into two groups: group A – 50 patients with confirmed signs of meniscal root injury according to the data of magnetic resonance imaging (MRI); group B – 50 patients without significant damage to the cartilage, menisci, or ligaments of the knee joint. Morphometric parameters of the knee joint were evaluated and analyzed based on the MRI data (width and index of the femoral intercondylar notch, posterior slope of the medial tibial condyle, concavity of the articular surface of the medial tibial condyle, curvature and slope of the articular surface of the femoral condyles, height of the tibial intercondylar tubercles).

Results . In patients of group A, a narrower femoral intercondylar notch and an increased posterior slope of the tibial medial condyle were identified (p ≤ 0,05), as well as a tendency toward flattening and enlargement of femoral and tibial condyles compared to the same parameters in group B. When comparing the height of the tibial intercondylar tubercles between the studied groups, no correlation was found. Osteophytes were identified in the intercondylar notch (in 90% of cases), first corresponded to the attachment area of the anterior meniscofemoral ligament of the lateral meniscus (mean height: 2,5 mm), and the second – to the attachment area of the posterior meniscofemoral ligament of the lateral meniscus (mean height: 2,7 mm).

Conclusion. The anatomical features identified (intercondylar notch narrowing, flattening of the articular surface of the tibial medial condyle, and an increased slope of its posterior edge), as well as the significant role of the ratio of the heights of the femoral and tibial medial condyles, are of considerable importance and may be used as an additional diagnostic criterion for detection of medial meniscus posterior root tear.

1. Hantouly A.T., Aminake G., Khan A.S. et al. Meniscus root tears: state of the art. Int. Orthop. 2024;48(4):955- 964. DOI: 10.1007/s00264-024-06092-w.

2. Fedoseyev A.V., Chekushin A.A., Tishkin R.V. et al. Complex approach in examination of function of the knee joint in patients with osteoarthritis. I.P. Pavlov Russian Medical Biological Herald. 2023;31(2):317-328. DOI: 10.17816/PAVLOVJ109633. (In Russ.)

3. Kalske R., Kiadaliri A., Sihvonen R. et al.; FIDELITY (Finnish Degenerative Meniscal Lesion Study) Investigators. Arthroscopic partial meniscectomy for a degenerative meniscus tear is not cost effective compared with placebo surgery: An economic evaluation based on the FIDELITY trial data. Clin. Orthop. Relat. Res. 2024;482(9):1523-1533. DOI: 10.1097/CORR.0000000000003094.

4. Lu S.X., Ding L., Chen Q. et al. Progress on treatment of posterior angle injury of medial meniscus of knee joint under arthroscopy. Zhongguo Gu Shang. 2025;38(6):651-656. DOI: 10.12200/j.issn.1003-0034.20240088. (In Chinese)

5. Bi A.S., Cole W.W. 3rd, Lowe D. et al. Surgical technique, tips, and tricks: medial implantable shock absorber for medial compartment knee osteoarthritis. Video J. Sports Med. 2025;5(3):26350254241303551. DOI: 10.1177/26350254241303551.

6. Kodama Y., Furumatsu T., Masuda S. et al. Transtibial fixation for medial meniscus posterior root tear reduces posterior extrusion and physiological translation of the medial meniscus in middle-aged and elderly patients. Knee Surg. Sports Traumatol. Arthrosc. 2020;28(11):3416-3425. DOI: 10.1007/s00167-019-05810-x.

7. Garcia J.R., Boden S.A., Khan Z.A. et al. Risk factors for subchondral insufficiency fracture of the knee in the setting of medial meniscus posterior root tear. Am. J. Sports Med. 2025;53(9):2118-2127. DOI: 10.1177/03635465251346952.

8. Belova S.V., Zubavlenko R.A., Gladkova E.V. et al. Free radical oxidation and metabolic processes of cartilage and bone tissues in animals with surgical model of posttraumatic osteoarthrosis. I.P. Pavlov Russian Medical Biological Herald. 2023;31(2):177-184. DOI: 10.17816/PAVLOVJ111575. (In Russ.)

9. Matveeva E.L., Spirkina E.S., Chegurov O.K., Reva M.A. Profile environment lipid peroxidation in the synovial liquid in patients with gonarthrosis, accompanies defects articular surface. Science of the young (Eruditio Juvenium). 2020;8(1):70-75. DOI: 10.23888/HMJ20208170-75. (In Russ.)

10. Swamy N., Wadhwa V., Bajaj G. et al. Medial meniscal extrusion: Detection, evaluation and clinical implications. Eur. J. Radiol. 2018;102:115-124. DOI: 10.1016/j.ejrad.2018.03.007.

11. Injury of the Knee Joint Meniscus. Clinical Guidelines. 2024. URL: https://cr.minzdrav.gov.ru/previewcr/862_1 (accessed 16.04.2026).

12. Kozaki T., Fukui D., Yamamoto E. et al. Medial meniscus extrusion and varus tilt of joint line convergence angle increase stress in the medial compartment of the knee joint in the knee extension position – finite element analysis. J. Exp. Orthop. 2022; 9(1): 49. DOI: 10.1186/s40634-022-00490-y.

13. Çamur E., Duran S. Relationship of medial meniscus posterior root tears with proximal tibial morphology and knee osteoarthritis. J. Knee Surg. 2025;38(9):433- 439. DOI: 10.1055/a-2525-4565.

14. Lim S., Chung J.Y., Park J.Y. et al. Medial meniscus posterior horn horizontal tears are associated with knee posteromedial impinging structures inducing shearing forces in patients with meniscus degeneration. Cartilage. 2025 Jul 3:19476035251347728. DOI: 10.1177/19476035251347728.

15. Imhoff F.B., Fucentese S.F., Harrer J., Tischer T. The infl uence of axial deformities and their correction on the development and progression of osteoarthritis. Orthopade. 2021;50(5):378-386. DOI: 10.1007/s00132-021-04103-x. (In German)

16. Wang P., Gao F., Sun W. et al. Morphometric characteristics of the knee are associated with the injury of the meniscus. J. Orthop. Surg. Res. 2022;17(1):498. DOI: 10.1186/s13018-022-03380-2.

17. Domzalski M., Grzelak P., Gabos P. Risk factors for anterior cruciate ligament injury in skeletally immature patients: analysis of intercondylar notch width using Magnetic Resonance Imaging. Int. Orthop. 2010;34(5):703-707. DOI: 10.1007/s00264-010-0987-7.

18. Hudek R., Schmutz S., Regenfelder F. et al. Novel measurement technique of the tibial slope on conventional MRI. Clin. Orthop. Relat. Res. 2009;467(8):2066- 2072. DOI: 10.1007/s11999-009-0711-3.

19. Kiapour A.M., Yang D.S., Badger G.J. et al. Anatomic features of the tibial plateau predict outcomes of ACL reconstruction within 7 years after surgery. Am. J. Sports Med. 2019;47(2):303-311. DOI: 10.1177/0363546518823556.

20. Musahl V., Ayeni O.R., Citak M. et al. The infl uence of bony morphology on the magnitude of the pivot shift. Knee Surg. Sports Traumatol. Arthrosc. 2010;18(9):1232-1238. DOI: 10.1007/s00167-010-1129-x.