Advances in the understanding of the biomechanical consequences of meniscal root tears has led to an increased interest in the diagnosis and treatment of these tears. Medial meniscus posterior root tears are usually seen in middle aged women with mild degenerative changes in the knee. Discontinuity of the radial collagen fibers of the meniscus results in complete loss of meniscal load bearing function. Extrusion on the meniscus and increased contact stresses in the medial compartment lead to rapid progression of osteoarthritis. Repair of meniscal root tears in patients without advanced arthritic changes may delay the progression of osteoarthritis, and provide symptomatic relief. Good mid-term results have been reported with medial meniscal root repairs using transtibial techniques or suture anchors. Varus malalignment should be corrected with proximal tibial osteotomy during meniscal repair. Lateral meniscal root tears are usually associated with anterior cruciate ligament injuries in younger patients. The posterior horn of the lateral meniscus plays an important role in the prevention of pivot-shift, and every effort should be made to repair these tears during anterior cruciate ligament reconstruction.