Meniscus root tears (MRTs) are significant knee injuries that have historically been underdiagnosed and undertreated. However, their clinical and functional significance has gained recent attention, particularly due to their frequent association with anterior cruciate ligament (ACL) injuries. This comprehensive review discusses various aspects of MRTs, including epidemiology, biomechanics, etiology, clinical and radiological findings, classification, management, and surgical techniques. **Epidemiology:** MRTs account for about 20% of all meniscal tears, with degenerative medial meniscus posterior root tears being the most common subtype. They are more prevalent in obese individuals, older adults, and those with sedentary lifestyles. Recent studies suggest that the incidence of medial MRTs is higher in populations with frequent squatting, kneeling, and sitting on the floor. **Biomechanics:** Menisci play a crucial role in knee function by acting as shock absorbers and stabilizers. Meniscus root injuries are equivalent to total meniscectomy in terms of biomechanical impact, leading to gradual damage to articular cartilage and arthritis. **Etiology and Mechanism of Injury:** Posterior roots are more commonly affected than anterior roots. Medial MRTs are often associated with age-related degenerative changes and low-energy repetitive trauma, while lateral MRTs are more common in young males with acute ACL injuries. **Clinical Features:** Diagnosing MRTs can be challenging due to limited sensitivity and specificity of symptoms. Patients may present with chronic, subtle symptoms, such as posterior knee pain and restricted range of motion. Physical examination and imaging techniques are essential for accurate diagnosis. **Radiological Findings:** MRI is the preferred imaging modality for diagnosing MRTs, with higher sensitivity but less specificity for medial MRTs compared to lateral MRTs. Direct signs on MRI include high signal in the meniscus root region, the "Cleft" sign, and the "Ghost" sign. **Classification:** Laprade's classification system is widely used, categorizing MRTs into five types based on their morphology during arthroscopic assessment. **Treatment Algorithm:** Management depends on injury severity, time of injury, and articular cartilage status. Conservative treatment, partial meniscectomy, and surgical repair are the main options. Surgical repair aims to restore knee kinematics and delay osteoarthritis progression. **Surgical Technique:** Transtibial pullout repair is considered the gold standard, providing anatomical reduction and restoring meniscus stability. Suture anchor techniques are also used but less commonly. **Post-operative Rehabilitation:** Rehabilitation follows four stages: protecting the repair, gaining full weight-bearing, maintaining ROM and strengthening, and returning to sports. Prognosis remains challenging, as meniscal root repairs only partially restore native knee kinematics and do not completely prevent osteoarthritis progression. However, anatomic repairs showMeniscus root tears (MRTs) are significant knee injuries that have historically been underdiagnosed and undertreated. However, their clinical and functional significance has gained recent attention, particularly due to their frequent association with anterior cruciate ligament (ACL) injuries. This comprehensive review discusses various aspects of MRTs, including epidemiology, biomechanics, etiology, clinical and radiological findings, classification, management, and surgical techniques. **Epidemiology:** MRTs account for about 20% of all meniscal tears, with degenerative medial meniscus posterior root tears being the most common subtype. They are more prevalent in obese individuals, older adults, and those with sedentary lifestyles. Recent studies suggest that the incidence of medial MRTs is higher in populations with frequent squatting, kneeling, and sitting on the floor. **Biomechanics:** Menisci play a crucial role in knee function by acting as shock absorbers and stabilizers. Meniscus root injuries are equivalent to total meniscectomy in terms of biomechanical impact, leading to gradual damage to articular cartilage and arthritis. **Etiology and Mechanism of Injury:** Posterior roots are more commonly affected than anterior roots. Medial MRTs are often associated with age-related degenerative changes and low-energy repetitive trauma, while lateral MRTs are more common in young males with acute ACL injuries. **Clinical Features:** Diagnosing MRTs can be challenging due to limited sensitivity and specificity of symptoms. Patients may present with chronic, subtle symptoms, such as posterior knee pain and restricted range of motion. Physical examination and imaging techniques are essential for accurate diagnosis. **Radiological Findings:** MRI is the preferred imaging modality for diagnosing MRTs, with higher sensitivity but less specificity for medial MRTs compared to lateral MRTs. Direct signs on MRI include high signal in the meniscus root region, the "Cleft" sign, and the "Ghost" sign. **Classification:** Laprade's classification system is widely used, categorizing MRTs into five types based on their morphology during arthroscopic assessment. **Treatment Algorithm:** Management depends on injury severity, time of injury, and articular cartilage status. Conservative treatment, partial meniscectomy, and surgical repair are the main options. Surgical repair aims to restore knee kinematics and delay osteoarthritis progression. **Surgical Technique:** Transtibial pullout repair is considered the gold standard, providing anatomical reduction and restoring meniscus stability. Suture anchor techniques are also used but less commonly. **Post-operative Rehabilitation:** Rehabilitation follows four stages: protecting the repair, gaining full weight-bearing, maintaining ROM and strengthening, and returning to sports. Prognosis remains challenging, as meniscal root repairs only partially restore native knee kinematics and do not completely prevent osteoarthritis progression. However, anatomic repairs show