Different Types of Meniscal Tears

In a recent blog post, we discussed meniscal tears and treatment of these injuries.  Today we will take a look at the 3 different shapes of meniscal tears. To recap, the meniscus is a c-shaped piece of cartilage in the knee that acts as a cushion between the thigh bone and shin bone. The primary function of the meniscus is to keep the knee stable and act as a shock absorber.

Types of Meniscal Tears:

1.      Longitudinal 
2.      Radial 
3.      Horizontal
  
Longitudinal Meniscal Tears

A longitudinal tear runs along the meniscus.  If the longitudinal tear is partial, it can heal without surgical intervention. If it does not heal properly, however, it can often lead to a full bucket handle tear (a complete tear that goes through the meniscus). Longitudinal tears are very common in young athletes and often present in conjunction with an ACL tear.

Radial Tears

Radial Tears occur along the inner edge of the meniscus and can be either partial or full.  Two common radial tears are oblique tears and parrot’s beak tears.  Oblique tears are probably the most common type of meniscal tears.  

Horizontal Tears

This type of tear goes through the meniscus and splits the meniscus into a top and bottom section. These tears are not as common and often begin as a result of degeneration or a minor injury.  Unfortunately, if left untreated, horizontal tears can leave the patient more susceptible to the more serious horizontal flap tear and can become complicated to fix. 

Developing a Treatment Plan:

It is important to remember that there are some key factors to consider when developing a treatment plan for a meniscal tear.  These factors include:

1. Patient’s age
2. Patient’s activity level 
3. Shape/location of the tear (complex tears can be a combination of longitudinal, radial and horizontal)
4. Related injuries (if any) that are present

Age and activity level are important to the success of a surgical repair of the meniscus. The younger and more active the patient, the more likely the repair will be successful. It is also extremely important to evaluate other injuries. For example, if you repair the meniscus, but fail to repair an ACL tear, recovery will be compromised. A full evaluation of each patient is necessary to determine an appropriate treatment plan.

If you feel you have a meniscal tear, it is important to see a doctor and he/she will develop a treatment plan that is best for you. 

Ask the Orthopedic Surgeon: What is the meniscus?

Question:
I keep hearing of athletes tearing their meniscus.  What exactly is the meniscus and what does it do and what happens if it is torn?

Answer: 

What is the meniscus?
The meniscus is a c-shaped piece of cartilage in the knee that acts as a cushion between thigh bone and shin bone.  The meniscus acts as a shock absorber and keeps the knee stable.  The meniscus also distributes our weight evenly over the knee. The most common causes of a meniscal tear are a sudden twist of the knee or overuse.

What are the symptoms of a torn meniscus?

-        A “pop” may be felt at the time of the injury

-        Pain

-        Stiffness & Swelling

-        Limited range of motion

-        “Locking or Catching”

How is a torn meniscus treated?

Treatment of meniscal tears vary depending on the size, severity and location of the tear.  Tears that are small in size and on the outer edge of the meniscus may not require surgery.  In these cases, the protocol is RICE:  Rest, Ice, Compression and Elevation combined with anti-inflammatory medications (aspirin or ibruprofen). The patient may or may not be required to wear a brace.

If the meniscal tear is moderate to severe, a knee arthroscopy is often needed. Knee arthroscopies are performed through a small incision in the knee.  An orthopedic surgeon then inserts a small camera, which provides a clear view of the knee.  From there, the orthopedic surgeon either repairs the tear or removes the torn portion of the menisci.

Depending on the location of the tear, an orthopedic surgeon decides whether to remove or repair a tear.  The outer layer of the meniscus is often referred to as the ‘red zone’ because it has a good blood supply, which is necessary for healing.  The inner layer is sometimes referred to as the ‘white zone’, which lacks a decent blood supply and makes healing difficult.  If the tear is located in the red zone it is normally repaired, but if it is in the white zone, it is normally fully or partially removed.  Full removal is normally avoided, if possible, as it can leave the patient more prone to osteoarthritis in the future.

For a meniscal repair, the recovery time is about 3 months, with 4-6 weeks on crutches and physical therapy.  A partial menisectomy (removal of the meniscus) has a recovery time of about 6 weeks and only 3 days on crutches.  Physical therapy is needed as well.  In both cases, patients are able to return to full activity. 

If you have an orthopedic question for John Vitolo, MD, please email your question to kim_abbasi@skyvieworthopedic.com.  John Vitolo, MD is Board Certified in Orthopedic Surgery and Sports Medicine.  Skyview Orthopedic has offices in Sparta and Randolph.

*Picture Source:  American Academy of Orthopedic Surgeons