Meniscus root tears (MRTs) are significant knee pathologies that have historically been underdiagnosed and undertreated. However, their association with anterior cruciate ligament (ACL) injuries has increased their clinical recognition. MRTs account for about 20% of all meniscal tears, with degenerative medial meniscus posterior root tears being the most common subtype. These tears are frequently found in obese, sedentary individuals over 50 years old. Recent studies suggest that the actual prevalence of MRTs may be higher than reported. MRTs are associated with both degenerative changes and low-energy repetitive trauma, such as deep squatting. Medial MRTs are more common in older patients, females, and obese individuals, while lateral MRTs are often seen in young males with ACL injuries. MRI is the preferred imaging modality for diagnosing MRTs, with direct and indirect signs aiding in diagnosis. Arthroscopic visualization remains the gold standard for confirmation. Laprade's classification system is widely used to categorize MRTs based on tear morphology. Treatment options include conservative management, partial meniscectomy, and surgical repair. Surgical repair, particularly using the transtibial pullout technique, is recommended for young, active patients with minimal cartilage damage. However, advanced osteoarthritis and other factors may contraindicate repair. Post-operative rehabilitation involves multiple phases focusing on protecting the repair, restoring motion, and returning to normal activities. While meniscal root repair aims to restore knee function, biomechanical studies show it only partially restores native kinematics, and does not completely prevent the progression of osteoarthritis. Patients who undergo anatomic repair show significant improvements in pain, function, and activity levels. The prognosis is generally favorable, but long-term outcomes depend on various factors.Meniscus root tears (MRTs) are significant knee pathologies that have historically been underdiagnosed and undertreated. However, their association with anterior cruciate ligament (ACL) injuries has increased their clinical recognition. MRTs account for about 20% of all meniscal tears, with degenerative medial meniscus posterior root tears being the most common subtype. These tears are frequently found in obese, sedentary individuals over 50 years old. Recent studies suggest that the actual prevalence of MRTs may be higher than reported. MRTs are associated with both degenerative changes and low-energy repetitive trauma, such as deep squatting. Medial MRTs are more common in older patients, females, and obese individuals, while lateral MRTs are often seen in young males with ACL injuries. MRI is the preferred imaging modality for diagnosing MRTs, with direct and indirect signs aiding in diagnosis. Arthroscopic visualization remains the gold standard for confirmation. Laprade's classification system is widely used to categorize MRTs based on tear morphology. Treatment options include conservative management, partial meniscectomy, and surgical repair. Surgical repair, particularly using the transtibial pullout technique, is recommended for young, active patients with minimal cartilage damage. However, advanced osteoarthritis and other factors may contraindicate repair. Post-operative rehabilitation involves multiple phases focusing on protecting the repair, restoring motion, and returning to normal activities. While meniscal root repair aims to restore knee function, biomechanical studies show it only partially restores native kinematics, and does not completely prevent the progression of osteoarthritis. Patients who undergo anatomic repair show significant improvements in pain, function, and activity levels. The prognosis is generally favorable, but long-term outcomes depend on various factors.