No 2 Meniscus Tears are the Same: When & How to Treat Them

Your menisci are small, yet essential parts of your knee joint. These strong fibrocartilage cushions fill the space between your femur and your tibia. They match the knee’s shape so perfectly they hold up 50% of the force across each knee joint. They also aid in joint stability and function as the knee moves. Tears can be different within each meniscus. The type and extent of this tear will dictate the best treatment for your injury. Here’s a closer look at the different types of meniscus tears and the best treatments for each.

Types Of Meniscus Tears

There are two menisci in your knee: one on the inside part of the knee (the medial meniscus) and one on the outer side of the knee (the lateral meniscus). Each meniscus is shaped like the letter “C” and keep the bones gliding smoothly as the knee moves. Because of their key role, it’s easy to see how an injury to your meniscus can greatly alter knee function. A meniscus tear can lead to pain, locking, catching, swelling and gait changes. If left untreated there is an increased risk of arthritic degeneration.

Meniscus tears can develop after acute trauma or repetitive stress, especially if the natural aging process has weakened the area. Workers, weekend warriors, and competitive athletes of all ages who regularly twist their knees are at an increased risk for meniscus tears.

Let’s take a closer look at different meniscus tears:  

• Simple flap or beak tear: These are often small tears that involve the area that has almost no direct blood supply. They can be annoying just the same and are best treated by simple removal of the torn piece using a fiberoptic scope (commonly known as knee arthroscopy). Note: A “Knee scope” is the best way to treat almost every type of tear. That said, every procedure will be different, with unique post op instructions. So don’t be fooled - not all scopes are the same and pending on the type of treatment, recoveries differ as well.
• Intrasubstance Tear: An intrasubstance and horizontal tear typically results from repetitive use, or a non-trauma injury that can be worsened by natural aging and degeneration. Mild tears may not require surgical intervention. Popular treatments include anti-inflammatories, Glucosamine/Chondroitin, injections, PRP (Platelet enRiched Plasma), lubricants and, of course, physical therapy. These tears are located within the meniscus, without extending to an edge.
• Longitudinal Tear: A longitudinal tear is one that develops lengthwise on the meniscus, parallel to its inner and outer edges. Small longitudinal tears may be treated conservatively in the same way we treat intrasubstance tears.
• Horizontal Cleavage Tears: These are the next stage of the tears above (Intrasubstance and Longitudinal). These tears break through the edge, become unstable and cause pain, swelling or locking. Horizontal cleavage tears may be treated arthroscopically by removing loose pieces or repairing the tear. Pending the type and extent of the tear, Dr. Reznik sometimes prefers to sew in a fibrin clot made from your own blood to promote local healing.
• Radial Tear: This type of tear develops from the inner portion of the meniscus towards the outer portion, and it doesn’t have a great blood supply, meaning conservative care can only do so much. Oftentimes surgery is the best path forward for patients with radial meniscus tears.
• Bucket-Handle Tear: This is a subset of the longitudinal tear, but it can cause more symptoms because part of the tear can “flip” like a bucket handle and become compressed when the knee bends. Surgery is typically performed to address this type of tear. Larger bucket-handle tears can flip and get stuck in the middle of the knee. This is called a “locked knee” and this condition must be treated with surgery. Forcing the knee to straighten with aggressive stretching may make the tear worse.
• Complex Tear: A complex tear occurs when multiple tear types are seen together in the same knee. Surgery is almost always performed to manage these complex tears.

Less common but important tears are:

• Ramp Lesion: A ramp lesion tear is a “newer” named type of tear. It is in the back of the meniscus, at the very outer edge, the most “posterior” portion of the medial meniscus. This area has a very healthy blood flow, and very small tears in younger patients may heal. Larger tears cause locking and need a repair. They also heal well with surgery.  
• Root Tear: This is one of the most talked about tears in the newer literature on knee injury. It’s often marked by a pop and then pain with walking and is more common in people between the ages of 40 and 60. Many times, people cannot weight bear without pain after a root tear. It is associated with rapid onset of arthritis.

Your menisci can tear in many different ways and knowing exactly what you’re dealing with is key to getting you the right type of treatment. Because the menisci don’t always have great blood flow, surgery may be necessary depending on the exact location of your tear.

A consultation with a knee specialist, X-rays and a good exam are key to the best diagnosis. If there are still clear signs of a possible tear and simple treatments have not worked, diagnostic imaging exams like an MRI can help to determine your ideal treatment plan.

For more information about meniscus tears, or to learn more about different issues that can affect the large joints in your body, pick up a copy of Dr. Reznik’s most popular publication, The Knee & Shoulder Handbook.

To see some of how this surgery is done through the arthroscope, check out Dr. Reznik’s media page.