The treatment for a tear depends on what part of the meniscus is injured, and also takes into account a variety of factors, including the person’s age, whether there was any response to nonsurgical treatment, and if there is other damage to the knee besides a torn meniscus.
Here are the six most common types of meniscus tears and how they are treated.
Radial Tear
Radial tears 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 without treatment.
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 with arthroscopic surgery meniscus with arthroscopic surgery.
Intrasubstance/Incomplete Tear
When people are in their 20s or 30s, doctors commonly see intrasubstance changes (also called incomplete tears) of the meniscus on a magnetic resonance imagining test (MRI). Often, these kinds of tears are a sign of early degenerative changes of the meniscus (those that happen as a result of wear and tear and get worse over time).
Incomplete and intrasubstance meniscus tears are considered “stable” injuries. That means they generally do not require surgical treatment.
Horizontal Tear
A horizontal tear 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 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. A complex tear often involves both radial and horizontal tears.
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 of the knee.
Bucket-Handle Tear
A bucket-handle tear is a prominent type of horizontal meniscal tear. 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 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.
