Table of ContentsView AllTable of ContentsRadialLongitudinalHorizontalBucket HandleFlapRampComplexTear LocationsRecovery
Table of ContentsView All
View All
Table of Contents
Radial
Longitudinal
Horizontal
Bucket Handle
Flap
Ramp
Complex
Tear Locations
Recovery
Types ofmeniscustears include radial, horizontal, flap, complex, and bucket-handle. All can compromise the knee, where this C-shaped cartilage is found. The part of the meniscus these tears affect, the patterns they exhibit, and their complexity differ, however.
Treatment for meniscus tear depends on the type, and factors such as a person’s age and the cause. Other factors include whether and how non-surgical treatment worked and if there is additional knee damage with thetorn meniscus.
1. Radial Tear
Radial tears are the most common type of meniscus tear.They occur within theavascularzone of the meniscus, the part that does not have a blood supply.
Because of where they are located, there is little capacity for these tears to heal without treatment. No blood supply means no red blood cells to repair tissue. They can lead to early osteoarthritis. While historically considered irreparable, current treatment focuses on trying to save the meniscus.
Arthroscopic surgerytypically is needed, but the techniques and outcomes depend on factors that include whether a full or partial tear has occurred. Conservative treatment may be an option, especially with degenerative (wear and tear) damage rather than traumatic causes (injuries).
A root tear is a type of radial tear that occurs at the root segment of the meniscus.
2. Longitudinal Tear
A longitudinal meniscus tear runs lengthwise along the meniscus. Depending on the specific injury, a longitudinal tear has access to blood supply and may be able to heal on its own.
Studies have demonstrated that longitudinal and radial tears lead to different mechanical behaviors affecting the knee and leg, and there may be benefits to using different repair techniques.
3. Horizontal Tear
Intrasubstance changes (also called horizontal tears) are a type of longitudinal tear. These tears often are a sign of early degenerative changes of the meniscus due to wear and tear that worsens over time. Healthcare providers commonly see this type of meniscus tear in people older than age 40.
These tears run parallel to the top of the tibia (a lower leg bone) and involve one of the joint surfaces or edges. They may be considered “stable” injuries that don’t necessarily progress. Conservative treatment is common and surgery may not be needed.
Healing and Horizontal TearsThe location of a horizontal tear determines the healing potential and course of treatment:Tears within the vascular portion:Repair may be a good option.Rather than removing the damaged portion of the meniscus, a surgeon may sew a horizontal tear together.Centrally located horizontal tearswill not heal—even if surgery is performed.
Healing and Horizontal Tears
The location of a horizontal tear determines the healing potential and course of treatment:Tears within the vascular portion:Repair may be a good option.Rather than removing the damaged portion of the meniscus, a surgeon may sew a horizontal tear together.Centrally located horizontal tearswill not heal—even if surgery is performed.
The location of a horizontal tear determines the healing potential and course of treatment:
4. Bucket Handle Tear
Abucket-handle tearis a type of longitudinal tear that occurs in the center of the meniscus.These tears often cause the knee to become stuck because the torn portion of the meniscus blocks normal knee motion.
The orientation of a bucket-handle tear is typically vertical.Bucket-handle tears often require more urgent surgical treatment to allow the knee to start bending again.
Which Types of Meniscus Tears Require Surgery?Not every meniscus tear needs surgery. Whether or not surgery is indicated depends on the size, location, and pattern of the tear. For example, a bucket-handle tear requires surgery, but a radial tear may not. Surgery is usually considered if conservative treatment isn’t working and/or you have a lot of pain, and the pain gets in the way of normal daily function.
Which Types of Meniscus Tears Require Surgery?
Not every meniscus tear needs surgery. Whether or not surgery is indicated depends on the size, location, and pattern of the tear. For example, a bucket-handle tear requires surgery, but a radial tear may not. Surgery is usually considered if conservative treatment isn’t working and/or you have a lot of pain, and the pain gets in the way of normal daily function.
5. Flap Tear
A flap tear of the meniscus is a type of displaced tear. This means part of the structure has detached or is only partly attached.For example, part of the cartilage can peel back and can get stuck in the knee joint, causing it to “catch” or lock up.
A flap tear can occur with either a horizontal or vertical tear. If the flap causes the knee to catch, a surgeon can usually fix it without removing much tissue.
6. Ramp Lesion
A ramp lesion is a tear in a part of the medial meniscus, at the back “horn” of the structure. The region where the tear occurs has good blood flow, which can mean that a smaller injury may be able to heal on its own without a surgical intervention.
A ramp lesion tear often occurs with other injuries, though, notably the anterior cruciate ligament (ACL) tear.Repair also is recommended when the lesion is larger than 2 centimeters in length.
7. Complex Tear
A complex meniscus tear means there is a combination of tear patterns.This often involves both radial and vertical tears.
Because complex tears are complicated, surgery to repair them isn’t always an option. However, a surgeon can remove some torn meniscus while repairing other portions of the knee in some unusual circumstances. New techniques for treatment, such as bone marrow injections and other biologics, continue to evolve.
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 the following:
A healthcare provider will recommend specific steps to help the cartilage heal and reduce discomfort, such as:
You may begin physical therapy after the swelling goes down and you can put weight on the affected knee. Depending on the severity of your injury, you may need to do physical therapy for four to eight weeks or longer. You will also develop strategies to prevent further knee injuries.
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, its location, and whether or not there is blood flow in the affected area.
19 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Academy of Orthopaedic Surgeons. OrthoInfo.Meniscus tears.Patil SS, Shekhar A, Tapasvi SR.Meniscal preservation is important for the knee joint.Indian J Orthop. 2017;51(5):576–587. doi:10.4103/ortho.IJOrtho_247_17Mameri ES, Jackson GR, Gonzalez F, Kaplan DJ, Jawanda H, Batra A,et al.Meniscus Radial Tears: Current Concepts on Management and Repair Techniques.Curr Rev Musculoskelet Med. 2023 May;16(5):182-191. doi:10.1007/s12178-023-09831-5New York University Langone Health.Nonsurgical Treatments for Meniscus Tears.Hantouly AT, Aminake G, Khan AS, Ayyan M, Olory B, Zikria B,et al.Meniscus root tears: state of the art.Int Orthop. 2024 Apr;48(4):955-964. doi:10.1007/s00264-024-06092-wSukopp M, Frey J, Schwer J, Kalbitz M, Ignatius A, Seitz AM.Radial and longitudinal meniscus tears show different gapping patterns under stance phase conditions.J Orthop Res. 2024 May;42(5):1134-1144. doi:10.1002/jor.25743Hospital for Special Surgery.Torn Meniscus.Bochyńska AI, Hannink G, Verhoeven R, Grijpma DW, Buma P.The effect of tissue surface modification with collagenase and addition of TGF-β3 on the healing potential of meniscal tears repaired with tissue glues in vitro.J Mater Sci Mater Med. 2017;28(1):22. doi:10.1007/s10856-016-5832-0Cavendish PA, Coffey E, Milliron EM, Barnes RH, Flanigan DC.Horizontal cleavage tear meniscal repair using all-inside circumferential compression sutures.Arthroscopy Techniques. 2023;12(8):e1319-e1327. doi:10.1016/j.eats.2023.03.024Kambhampati SB.Bucket handle horizontal cleavage tear of medial meniscus with congenital deformity–A case report.J Arthrosc Jt Surg. 2019;6(3):146-8. doi:10.1016/j.jajs.2019.05.005Radiopaedia.Meniscal tear.Kramer DE, Kalish LA, Martin DJ, et al.Outcomes after the operative treatment of bucket-handle meniscal tears in children and adolescents.Orthop J Sports Med. 2019;7(1):2325967118820305. doi:10.1177/2325967118820305Beaufils P, Becker R, Kopf S, Matthieu O, Pujol N.The knee meniscus: management of traumatic tears and degenerative lesions.EFORT Open Rev. 2017;2(5):195–203. doi:10.1302/2058-5241.2.160056Kunze KN, Wright-Chisem J, Polce EM, DePhillipo NN, LaPrade RF, Chahla J.Risk Factors for Ramp Lesions of the Medial Meniscus: A Systematic Review and Meta-analysis.Am J Sports Med. 2021 Nov;49(13):3749-3757. doi: 10.1177/0363546520986817Gómez Cáceres A, Mariño IT, Martínez Malo FJ, Riestra IV, Idiart RP.Meniscal Ramp Lesion Repair Without the Need for a Posteromedial Portal.Arthrosc Tech. 2024 Jan 1;13(4):102902. doi:10.1016/j.eats.2023.102902Cho SD, Youm YS, Kim JH, Cho HY, Kim KH.Patterns and influencing factors of medial meniscus tears in varus knee osteoarthritis.Knee Surg Relat Res. 2016;28(2):142–146. doi:10.5792/ksrr.2016.28.2.142Ozeki N, Seil R, Krych AJ, Koga H.Surgical treatment of complex meniscus tear and disease: state of the art.J ISAKOS. 2021 Jan;6(1):35-45. doi:10.1136/jisakos-2019-000380Bolog NV, Andreisek G.Reporting knee meniscal tears: technical aspects, typical pitfalls and how to avoid them.Insights Imaging. 2016;7(3):385–398. doi:10.1007/s13244-016-0472-yLuvsannyam E, Jain MS, Leitao AR, Maikawa N, Leitao AE.Meniscus tear: pathology, incidence, and management.Cureus. 2022;14(5):e25121. doi:10.7759/cureus.25121
19 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Academy of Orthopaedic Surgeons. OrthoInfo.Meniscus tears.Patil SS, Shekhar A, Tapasvi SR.Meniscal preservation is important for the knee joint.Indian J Orthop. 2017;51(5):576–587. doi:10.4103/ortho.IJOrtho_247_17Mameri ES, Jackson GR, Gonzalez F, Kaplan DJ, Jawanda H, Batra A,et al.Meniscus Radial Tears: Current Concepts on Management and Repair Techniques.Curr Rev Musculoskelet Med. 2023 May;16(5):182-191. doi:10.1007/s12178-023-09831-5New York University Langone Health.Nonsurgical Treatments for Meniscus Tears.Hantouly AT, Aminake G, Khan AS, Ayyan M, Olory B, Zikria B,et al.Meniscus root tears: state of the art.Int Orthop. 2024 Apr;48(4):955-964. doi:10.1007/s00264-024-06092-wSukopp M, Frey J, Schwer J, Kalbitz M, Ignatius A, Seitz AM.Radial and longitudinal meniscus tears show different gapping patterns under stance phase conditions.J Orthop Res. 2024 May;42(5):1134-1144. doi:10.1002/jor.25743Hospital for Special Surgery.Torn Meniscus.Bochyńska AI, Hannink G, Verhoeven R, Grijpma DW, Buma P.The effect of tissue surface modification with collagenase and addition of TGF-β3 on the healing potential of meniscal tears repaired with tissue glues in vitro.J Mater Sci Mater Med. 2017;28(1):22. doi:10.1007/s10856-016-5832-0Cavendish PA, Coffey E, Milliron EM, Barnes RH, Flanigan DC.Horizontal cleavage tear meniscal repair using all-inside circumferential compression sutures.Arthroscopy Techniques. 2023;12(8):e1319-e1327. doi:10.1016/j.eats.2023.03.024Kambhampati SB.Bucket handle horizontal cleavage tear of medial meniscus with congenital deformity–A case report.J Arthrosc Jt Surg. 2019;6(3):146-8. doi:10.1016/j.jajs.2019.05.005Radiopaedia.Meniscal tear.Kramer DE, Kalish LA, Martin DJ, et al.Outcomes after the operative treatment of bucket-handle meniscal tears in children and adolescents.Orthop J Sports Med. 2019;7(1):2325967118820305. doi:10.1177/2325967118820305Beaufils P, Becker R, Kopf S, Matthieu O, Pujol N.The knee meniscus: management of traumatic tears and degenerative lesions.EFORT Open Rev. 2017;2(5):195–203. doi:10.1302/2058-5241.2.160056Kunze KN, Wright-Chisem J, Polce EM, DePhillipo NN, LaPrade RF, Chahla J.Risk Factors for Ramp Lesions of the Medial Meniscus: A Systematic Review and Meta-analysis.Am J Sports Med. 2021 Nov;49(13):3749-3757. doi: 10.1177/0363546520986817Gómez Cáceres A, Mariño IT, Martínez Malo FJ, Riestra IV, Idiart RP.Meniscal Ramp Lesion Repair Without the Need for a Posteromedial Portal.Arthrosc Tech. 2024 Jan 1;13(4):102902. doi:10.1016/j.eats.2023.102902Cho SD, Youm YS, Kim JH, Cho HY, Kim KH.Patterns and influencing factors of medial meniscus tears in varus knee osteoarthritis.Knee Surg Relat Res. 2016;28(2):142–146. doi:10.5792/ksrr.2016.28.2.142Ozeki N, Seil R, Krych AJ, Koga H.Surgical treatment of complex meniscus tear and disease: state of the art.J ISAKOS. 2021 Jan;6(1):35-45. doi:10.1136/jisakos-2019-000380Bolog NV, Andreisek G.Reporting knee meniscal tears: technical aspects, typical pitfalls and how to avoid them.Insights Imaging. 2016;7(3):385–398. doi:10.1007/s13244-016-0472-yLuvsannyam E, Jain MS, Leitao AR, Maikawa N, Leitao AE.Meniscus tear: pathology, incidence, and management.Cureus. 2022;14(5):e25121. doi:10.7759/cureus.25121
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
American Academy of Orthopaedic Surgeons. OrthoInfo.Meniscus tears.Patil SS, Shekhar A, Tapasvi SR.Meniscal preservation is important for the knee joint.Indian J Orthop. 2017;51(5):576–587. doi:10.4103/ortho.IJOrtho_247_17Mameri ES, Jackson GR, Gonzalez F, Kaplan DJ, Jawanda H, Batra A,et al.Meniscus Radial Tears: Current Concepts on Management and Repair Techniques.Curr Rev Musculoskelet Med. 2023 May;16(5):182-191. doi:10.1007/s12178-023-09831-5New York University Langone Health.Nonsurgical Treatments for Meniscus Tears.Hantouly AT, Aminake G, Khan AS, Ayyan M, Olory B, Zikria B,et al.Meniscus root tears: state of the art.Int Orthop. 2024 Apr;48(4):955-964. doi:10.1007/s00264-024-06092-wSukopp M, Frey J, Schwer J, Kalbitz M, Ignatius A, Seitz AM.Radial and longitudinal meniscus tears show different gapping patterns under stance phase conditions.J Orthop Res. 2024 May;42(5):1134-1144. doi:10.1002/jor.25743Hospital for Special Surgery.Torn Meniscus.Bochyńska AI, Hannink G, Verhoeven R, Grijpma DW, Buma P.The effect of tissue surface modification with collagenase and addition of TGF-β3 on the healing potential of meniscal tears repaired with tissue glues in vitro.J Mater Sci Mater Med. 2017;28(1):22. doi:10.1007/s10856-016-5832-0Cavendish PA, Coffey E, Milliron EM, Barnes RH, Flanigan DC.Horizontal cleavage tear meniscal repair using all-inside circumferential compression sutures.Arthroscopy Techniques. 2023;12(8):e1319-e1327. doi:10.1016/j.eats.2023.03.024Kambhampati SB.Bucket handle horizontal cleavage tear of medial meniscus with congenital deformity–A case report.J Arthrosc Jt Surg. 2019;6(3):146-8. doi:10.1016/j.jajs.2019.05.005Radiopaedia.Meniscal tear.Kramer DE, Kalish LA, Martin DJ, et al.Outcomes after the operative treatment of bucket-handle meniscal tears in children and adolescents.Orthop J Sports Med. 2019;7(1):2325967118820305. doi:10.1177/2325967118820305Beaufils P, Becker R, Kopf S, Matthieu O, Pujol N.The knee meniscus: management of traumatic tears and degenerative lesions.EFORT Open Rev. 2017;2(5):195–203. doi:10.1302/2058-5241.2.160056Kunze KN, Wright-Chisem J, Polce EM, DePhillipo NN, LaPrade RF, Chahla J.Risk Factors for Ramp Lesions of the Medial Meniscus: A Systematic Review and Meta-analysis.Am J Sports Med. 2021 Nov;49(13):3749-3757. doi: 10.1177/0363546520986817Gómez Cáceres A, Mariño IT, Martínez Malo FJ, Riestra IV, Idiart RP.Meniscal Ramp Lesion Repair Without the Need for a Posteromedial Portal.Arthrosc Tech. 2024 Jan 1;13(4):102902. doi:10.1016/j.eats.2023.102902Cho SD, Youm YS, Kim JH, Cho HY, Kim KH.Patterns and influencing factors of medial meniscus tears in varus knee osteoarthritis.Knee Surg Relat Res. 2016;28(2):142–146. doi:10.5792/ksrr.2016.28.2.142Ozeki N, Seil R, Krych AJ, Koga H.Surgical treatment of complex meniscus tear and disease: state of the art.J ISAKOS. 2021 Jan;6(1):35-45. doi:10.1136/jisakos-2019-000380Bolog NV, Andreisek G.Reporting knee meniscal tears: technical aspects, typical pitfalls and how to avoid them.Insights Imaging. 2016;7(3):385–398. doi:10.1007/s13244-016-0472-yLuvsannyam E, Jain MS, Leitao AR, Maikawa N, Leitao AE.Meniscus tear: pathology, incidence, and management.Cureus. 2022;14(5):e25121. doi:10.7759/cureus.25121
American Academy of Orthopaedic Surgeons. OrthoInfo.Meniscus tears.
Patil SS, Shekhar A, Tapasvi SR.Meniscal preservation is important for the knee joint.Indian J Orthop. 2017;51(5):576–587. doi:10.4103/ortho.IJOrtho_247_17
Mameri ES, Jackson GR, Gonzalez F, Kaplan DJ, Jawanda H, Batra A,et al.Meniscus Radial Tears: Current Concepts on Management and Repair Techniques.Curr Rev Musculoskelet Med. 2023 May;16(5):182-191. doi:10.1007/s12178-023-09831-5
New York University Langone Health.Nonsurgical Treatments for Meniscus Tears.
Hantouly AT, Aminake G, Khan AS, Ayyan M, Olory B, Zikria B,et al.Meniscus root tears: state of the art.Int Orthop. 2024 Apr;48(4):955-964. doi:10.1007/s00264-024-06092-w
Sukopp M, Frey J, Schwer J, Kalbitz M, Ignatius A, Seitz AM.Radial and longitudinal meniscus tears show different gapping patterns under stance phase conditions.J Orthop Res. 2024 May;42(5):1134-1144. doi:10.1002/jor.25743
Hospital for Special Surgery.Torn Meniscus.
Bochyńska AI, Hannink G, Verhoeven R, Grijpma DW, Buma P.The effect of tissue surface modification with collagenase and addition of TGF-β3 on the healing potential of meniscal tears repaired with tissue glues in vitro.J Mater Sci Mater Med. 2017;28(1):22. doi:10.1007/s10856-016-5832-0
Cavendish PA, Coffey E, Milliron EM, Barnes RH, Flanigan DC.Horizontal cleavage tear meniscal repair using all-inside circumferential compression sutures.Arthroscopy Techniques. 2023;12(8):e1319-e1327. doi:10.1016/j.eats.2023.03.024
Kambhampati SB.Bucket handle horizontal cleavage tear of medial meniscus with congenital deformity–A case report.J Arthrosc Jt Surg. 2019;6(3):146-8. doi:10.1016/j.jajs.2019.05.005
Radiopaedia.Meniscal tear.
Kramer DE, Kalish LA, Martin DJ, et al.Outcomes after the operative treatment of bucket-handle meniscal tears in children and adolescents.Orthop J Sports Med. 2019;7(1):2325967118820305. doi:10.1177/2325967118820305
Beaufils P, Becker R, Kopf S, Matthieu O, Pujol N.The knee meniscus: management of traumatic tears and degenerative lesions.EFORT Open Rev. 2017;2(5):195–203. doi:10.1302/2058-5241.2.160056
Kunze KN, Wright-Chisem J, Polce EM, DePhillipo NN, LaPrade RF, Chahla J.Risk Factors for Ramp Lesions of the Medial Meniscus: A Systematic Review and Meta-analysis.Am J Sports Med. 2021 Nov;49(13):3749-3757. doi: 10.1177/0363546520986817
Gómez Cáceres A, Mariño IT, Martínez Malo FJ, Riestra IV, Idiart RP.Meniscal Ramp Lesion Repair Without the Need for a Posteromedial Portal.Arthrosc Tech. 2024 Jan 1;13(4):102902. doi:10.1016/j.eats.2023.102902
Cho SD, Youm YS, Kim JH, Cho HY, Kim KH.Patterns and influencing factors of medial meniscus tears in varus knee osteoarthritis.Knee Surg Relat Res. 2016;28(2):142–146. doi:10.5792/ksrr.2016.28.2.142
Ozeki N, Seil R, Krych AJ, Koga H.Surgical treatment of complex meniscus tear and disease: state of the art.J ISAKOS. 2021 Jan;6(1):35-45. doi:10.1136/jisakos-2019-000380
Bolog NV, Andreisek G.Reporting knee meniscal tears: technical aspects, typical pitfalls and how to avoid them.Insights Imaging. 2016;7(3):385–398. doi:10.1007/s13244-016-0472-y
Luvsannyam E, Jain MS, Leitao AR, Maikawa N, Leitao AE.Meniscus tear: pathology, incidence, and management.Cureus. 2022;14(5):e25121. doi:10.7759/cureus.25121
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