Findings on an MRI scan can be difficult for many to truly understand. As an orthopedic surgeon, I spend many visits with patients going over the MRI findings and help to make sense of them for you. This includes discussing meniscus tears, cartilage damage, cysts behind the knee, and more. There are two aspects to better understanding:
First, what are they talking about?
Second, is it a relevant finding to your particular situation ?

Let’s begin with a better understanding of what the findings mean. In this blog post, let’s go over the different types of meniscus tears.

Meniscus Tears

Meniscus tears are extremely common. An understanding of what the meniscus is will help you a lot to start. Try a few of my previous blog posts for more information. The meniscus a tissue that sits between the femur and tibia bone. It can tear in many different ways, and no two tears ever look the same. There are a few varieties frequently seen in MRI reports.

Radial meniscus tear

meniscus tearsA radial tear is a tear across the fibers of the meniscus. This causes damage to the functionality of the meniscus and often leads to a piece of meniscus that is unstable. This means it can flip around, get into a bad position and cause severe stabbing pain in your knee like being stuck with an icepick. When the tear goes back to its ‘happy place’ in a normal position, the pain goes away. These usually do not heal on their own.

Horizontal meniscus tear

meniscus tearsA horizontal tear is one in which the layers of tissue fibers have separated, but have not been cut. Often, the pain goes on for a longer period of time, and is not as severe as a radial tear. These tears can be quite extensive when seen at the time of surgery to repair them. Surgery is usually helpful to relieve pain, and they rarely heal on their own.

Bucket handle meniscus tear

A bucket handle tear is usually a very large tear, often so big that it looks like the handle of a bucket and can pop in and out. meniscus tearsOften, people with these tears have a knee that is stuck in a position and can not move. Some have a history of having their knee get stuck intermittently. Surgery is often needed urgently to get it ‘unstuck’ and either repair or trim it out. Most of these are very hard to repair if it has been there a while. If this is a new tear, urgent surgery can allow it to be saved and repaired.

Complex meniscus tear

Sometimes a tear can have components of each, or can’t simply be described by one term. These are common. Even at the time of surgery, it can be hard to use words to accurately describe its appearance, and the picture obtained at the time of surgery is the best way to understand exactly what it looks like. I usually explain these to my patients when i see them back in the office. These too usually don’t heal and need to be treated surgically.

Meniscal root tear

meniscus tearsA tear of the meniscal root means the tear is near where it attaches to the bone, usually far in the back. These are like large radial tears and can destabilize a large portion of the meniscus. Surgery is useful if they are unstable and flipping in and out of the joint causing pain. They can be significant for the future as their function to help protect the knee is severely limited.
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Degenerative incomplete meniscus tear

meniscus tearsA degenerative tear is often not the result of an injury, but occurs over time. The image often shows changes within the ‘meat’ or central aspect of the meniscus, but doesn’t look torn all the way through. Treatment decisions can be difficult, as some warrant repair and some do not. These are often associated with arthritis or cartilage damage as well.

Meniscus Tears
Meniscal repair

Meniscus tear grading scale

Tears are often graded by a radiologist. A grade 1 or 2 tear is usually within the heart of the meniscus, but would not be visible with a scope if we looked inside your knee. A grade 3 tear would clearly be visible.

In my experience, it is often difficult to characterize a tear by grade accurately, as I have the opportunity to not only read the report, but also see the knee inside for myself. If a tear is present, surgery is the only way to know for sure what it looks like and what the right treatment will be.

Not all tears need surgery. Some can heal while most don’t.

If you have questions about meniscus tears or have a meniscus tear on your MRI, feel free to contact me at Ask Dr. Hacker or through my office directly. Your comments are welcome below !

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