The 6 Types of Meniscus Tears

There are six types of meniscus tears: radial, intrasubstance, 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.

The treatment for a tear depends the type and factors such as a person's age, whether there was any response to non-surgical treatment, and if there is additional damage to the knee besides the torn meniscus.

This articles describes each of the types of meniscus tears and how they are treated.

Radial Tear

Radial tears are the most common type of meniscus tear. They occur within the avascular zone of the meniscus, the part that does not have a blood supply.

There is little capacity for these tears to heal without treatment because of where they are located. No blood supply means no red bloods cells to repair tissue.

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 with arthroscopic surgery.

Intrasubstance/Incomplete Tear

Intrasubstance changes (also called incomplete tears) are often a sign of early degenerative changes of the meniscus. They happen as a result of wear and tear and get worse over time.

Healthcare providers commonly see this type of meniscus tear on magnetic resonance imagining (MRI) performed on people in their 20s or 30s.

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. This type can occur in the vascular portion near the outer edge (the area with blood flow) or be more centrally located.

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 tears will not heal—even if surgery is performed.

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 meniscus tear means there is a combination of tear patterns. This often involves both radial and horizontal tears.

Surgery to repair complex tears is not normally done because of their complicated nature. 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 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.

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:

• Posterior horn tears are 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.
• Anterior horn tears are located in the front of the meniscus. They are less common.

Recovery

Radial tears, horizontal tears, bucket-handle tears, and flap tears may require surgery, while incomplete and complex tears are not repaired. Regardless, rest and rehabilitation will be required for a full recovery.

After the Injury

A healthcare provider will recommend certain steps to help the cartilage heal and reduce discomfort, such as:

• RICE (rest, ice, compression, and elevation): Ice and elevation are especially important to keep swelling down during the first few days after the injury. A compression bandage can also help keep swelling down.
• Walking aids: You'll need to avoid walking on your torn knee in the first weeks after the injury. A cane or crutches can help make sure you keep weight off the knee.
• Over-the-counter nonsteroidal anti-inflammatory medications (NSAIDs) to reduce pain and inflammation. For severe pain, prescription pain medication may be necessary.

Long-Term Recovery

Physical therapy can help you recover from a meniscus tear by decreasing pain, strengthening and improving the flexibility in your knee, and increasing its range of motion. You will also develop strategies to prevent further knee injuries.

You may begin physical therapy after the swelling goes down and you're able to put weight on the affected knee.

Depending on the severity of your injury, you may need to do physical therapy for between four and eight weeks or longer. 

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.