Background: The fibrocartilaginous meniscus is essential for the musculoskeletal stability of the knee joint. Damage or loss of this vital structure can lead to significant articulatory morbidity and an accelerated course of osteoarthritis. Therefore, attempts should be made to preserve the meniscus. Treatment and management of meniscal tears are dictated by multiple factors which include age, complexity of the tear, tissue quality, the severity of symptoms, etiology (traumatic versus atraumatic tear), and quantified surgical risk. The integrity of the meniscal root insertions is fundamental to preserve correct knee kinematics and avoid degenerative changes of the knee. Injuries to the meniscal attachments can lead to meniscal extrusion, decreased contact surface, increased cartilage stress, and ultimately articular degeneration. Recent and well designed studies have clarified the anatomy and biomechanics of the medial and lateral meniscal roots. Although the treatment of meniscal root tears is still controversial, many different techniques have been described for root repair. The goal of this review is to summarize the existing knowledge regarding meniscal root tears management.