The 6 Types of Meniscus Tears

Meniscus tears are a type of tear that occurs in the cartilage of the knee. These tears are a common cause of knee pain.

Many people with this injury end up having arthroscopic knee surgery. Arthroscopy uses narrow instruments inserted through small incisions to diagnose or treat joint problems.

But is surgery always necessary? And are all tears treated the same?

In practice, a variety of factors determine the best treatment for a meniscus tear. Some of these factors include:

• A person's age
• Results of nonsurgical treatment
• If there is any other damage besides a torn meniscus

This article explains six common types of meniscus tears and their treatment options.

Intrasubstance/Incomplete Tear

When people are in their 20s or 30s, doctors commonly see intrasubstance changes (also called incomplete tears) of the meniscus on an MRI. Often, these kinds of tears are a sign of early degenerative changes of the meniscus.

Incomplete and intrasubstance meniscus tears are considered "stable" injuries. That means they generally do not require surgical treatment.

Radial Tear

Radial tears of the meniscus (pictured in the middle of the top row on the image) are the most common type of meniscus tear.

These tears occur within the avascular zone of the meniscus. Avascular means there is no blood supply. Therefore, without blood supply, there is little capacity for these tears to heal.

When these kinds of tears get to the point of requiring surgical treatment, typically the only option is to trim out the damaged portion of the meniscus.

Horizontal Tear

A horizontal tear most commonly responds well to surgical meniscus repair. A horizontal tear (seen in the upper right corner of the image) runs along the curved fibers of the meniscus.

Rather than removing the damaged portion of the meniscus, a surgeon may sew a horizontal tear together. The key to determining the treatment of these tears is their location.

The vascular portion of the meniscus is the area of the cartilage with blood flow. It is located near the outer edge of the meniscus and has the best healing potential.

So, If a horizontal tear is within the vascular portion of the meniscus, repair may be a good option. However, when located more centrally, these tears will not heal, even if repaired.

Flap Tear

A flap tear of the meniscus, pictured in the bottom right corner of the image, is an unusual tear pattern. Part of the cartilage is peeled back and can get stuck in the joint, causing it to "catch" or lock up.

If the flap causes the knee to catch, a surgeon can usually fix it without removing much tissue at all.

Complex Tear

A complex tear means there is a combination of tear patterns. For example, a complex tear (shown in the middle image on the bottom row) often involves both radial and horizontal tear patterns.

Complex tears are not usually treated with surgical repair because of the complicated nature of the tear. However, in some unusual circumstances, a surgeon can remove some of the torn meniscus while repairing other portions.

Bucket-Handle Tear

A bucket-handle tear is a prominent type of horizontal tear of the meniscus. These tears often cause the knee to become stuck because the torn portion of the meniscus blocks normal knee motion.

Bucket-handle tears often require more urgent surgical treatment to allow the knee to start bending again.

Location of the Tear

In addition to describing the type of tear, most MRI and surgical reports will describe the location of the tear. Tear locations include:

• Anterior horn tears are less common and located in the front of the meniscus.
• Posterior horn tears are much more common and located in the back of the meniscus.
• Central tears are on the inner side of the meniscus. This part of the meniscus does not have a blood supply and is therefore not responsive to repair.
• Peripheral tears are located further on the outside of the meniscus. These are the types of tears that surgeons can sometimes repair.

Summary

Meniscus tears are injuries that occur in the cartilage of the knee. Sometimes these tears require surgical repair. However, whether they will respond well to surgery depends on the type of tear, the location, and blood flow in the area where the tear occurred.

A Word From Verywell

If your doctor told you that you have a meniscus tear, you might be wondering if that means you'll need surgery. Surgery can be a good option for some tears, but not all. So, talk to your doctor to understand what type of tear you have and whether you are a good candidate for surgical repair.