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Posterior root avulsions of the medial and lateral menisci result in decreased areas of tibiofemoral contact and increased tibiofemoral contact pressures. These avulsions may lead to the development of osteoarthritis. Therefore, two surgical techniques, the transtibial pullout repairand thesutureanchor repair, have recentlybeendeveloped to restore the native structure and function of the meniscal root attachment. Compared with the historical alternative of partial or total meniscectomy, these techniques allow for meniscal preservation and anatomic reduction of the meniscal roots, with the goal of preventing the development and progression of osteoarthritis. However, early biomechanical and clinical studies have reported conflicting results on the effectiveness of both techniques with regard to resisting displacement and facilitating healing. Although there is currently a lack of consensus on which is the superior technique, transtibial pullout and suture anchor repairs are increasingly used in clinical practice. The anterior and posterior meniscal roots anchor the medial and lateral menisci to the tibial plateau. Posterior root pathology is often caused by either acute injury or chronic degeneration1 and leads to altered tibiofemoral contact mechanics and the inability to convert axial loads into transverse hoop stresses2-6 (Figure 1). In one series, posterolateral meniscal root tears were observed in 8% of anterior cruciate ligament tears.7 Another study reported that up to 21.5% of medial meniscal tears may be located at the posterior root.8 The natural history of untreated meniscal root avulsions is poorly understood.On imaging studies, complete or partial posteromedial meniscal root avulsionshavebeenassociatedwith.3 mm of meniscal extrusion.9 Extrusion .3 mm has been linked to substantially increased articular cartilage loss and osteophyte formation.9 In addition, a comparison study of partial meniscectomy and meniscal repair for vertical longitudinal or bucket-handle tears of the medial meniscus reported a significant increase in osteoarthritis progression associated with partial meniscectomy at an 8-year followup.10 Historically, partial meniscectomy was used to manage meniscal root avulsions, and it is possible that similar effects would be seen in meniscal root avulsions treated with meniscectomy. Therefore, preservation of meniscal tissue and restoration of meniscal continuity is becoming the standard of care for posterior meniscal root pathology.11-13 Not all patients are candidates for root repair, however. Repair is indicated in active patients (typically aged ,50 years) following acute or chronic injury with no significant osteoarthritis (Outerbridge grade 3 or 4), joint-space narrowing, and malalignment.1,14 Moon et al14 examined the prognostic factors for February 2015, Vol 23, No 2 71 Robert F. LaPrade, MD, PhD Christopher M. LaPrade