Single-Stage Management of Anterior Cruciate Ligament Tear with Dual Menisci Bony Root Avulsion: A Rare Case Report and Review of Literature

Introduction: Posterior meniscal root tears affecting both menisci are rare occurrences, as their injury mechanisms differ significantly. While most root avulsions involve soft tissue, to our knowledge, bony avulsions of both posterior meniscal roots as discrete fragments have not been previously reported in the literature. Pang et al. (2025) described a unified intercondylar eminence fracture with both roots attached to a single fragment, but separate bony avulsion fractures of each root represent a distinct clinical challenge. Case Report: We present the case of a 28-year-old male with discrete bony avulsion fractures of both posterior meniscal roots accompanied by a concomitant anterior cruciate ligament (ACL) tear. The patient was managed with a single-staged arthroscopic procedure. ACL reconstruction was performed using quadrupled hamstring autograft (semitendinosus and gracilis) with adjustable-loop cortical button fixation on the femoral side and bioabsorbable interference screw fixation on the tibial side. Two separate trans-osseous tunnels were created - one for each discrete bony root fragment - with pullout sutures from each tunnel secured independently over a single cortical button. Conclusion: This case presented a unique surgical dilemma regarding the optimal fixation strategy for discrete dual bony root avulsions. The arthroscopic single-stage approach minimized surgical morbidity, facilitated early rehabilitation, and yielded favorable short-term outcomes. An extensive literature review of similar cases is presented in tabulated form, providing readers with a comprehensive comparison of various management strategies reported by multiple authors.