Each meniscus is anchored to the tibia by two ligamentous fixations, termed roots, one anterior and one posterior. These roots are the primary anchors of the menisci. The posterior root of the lateral meniscus also has two additional, albeit inconsistent, ligamentous attachments to the femur: the anterior and posterior meniscofemoral ligaments. Biomechanically, the consequences of meniscal root tears resemble those of a meniscectomy, as the meniscus loses its capacity to distribute axial loads into radial forces, often leading to early onset osteoarthritis in the affected knee compartment. The extent to which this applies to the posterolateral root, given its additional femoral attachment, remains debated. Clinically, tears predominantly involve the posterior roots. Posteromedial root tears are more common in obese women over 50, whereas posterolateral root tears typically occur in young men engaged in contact sports, such as football, often alongside anterior cruciate ligament (ACL) injuries. Clinical examination generally lacks specificity, though tenderness at the joint line may be elicited upon palpation. Magnetic resonance imaging plays a crucial role in diagnosing root tears, evidenced by fluid accumulation and the “ghost sign”—the radiographic absence of all or major parts of the meniscus root. Treatment options range from conservative management and arthroscopic debridement to arthroscopic repair, with the latter showing significant benefits over the former. This chapter will delve into the anatomy, biomechanics, and diagnostic approaches for meniscal root tears, followed by a discussion on the indications, contraindications for repair, repair techniques, and postoperative rehabilitation strategies.