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 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
A 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
A 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. Often, 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
A 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
A 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 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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I had a bucket handle tear back in my younger, more athletic years. I had no idea what that meant. It makes sense now. Thank you.
Glad this was helpful to you. Please let me know if you need any more info !
All the best,
My dad went in for an MRI scan last week. Unfortunately, the doctors told him that the MRI was broken and needed repairs before it could be used again. I hope it gets the repairs soon so my dad can get his MRI scan. I think he may have a meniscal root tear according to your information.
Meniscal root tears are very common, and I see them frequently in moderately arthritic knees. Please let me know if you have more questions I can answer.
Great post here. I came across your site while doing some research on a couple things for my own practice. Great work here.
Thanks. I’ve been working hard on this site fo years now. It’s always a work in progress ! Best wishes.
Dr.Scott, Thank you for taking your time to make Meniscal injuries understandable. I had an accident to my left knee and the pain was pretty unbearable for a few weeks. Long story short, after the protocol of Dr. appts , x-ray, 2 ortho specialists, who said give it time, because of still having pain after 12 weeks of ‘healing’ The MRI shows I have a complex lateral tear. I’m wondering if surgery or therapy is recommended. Thank you.
Hi Mary. In most cases a tear that does not heal in the first 3 months or so is not going to heal and I will often recommend surgery for it. Physical therapy does not help a tear heal, really ever, but works to strengthen the muscles around the knee so it works better. Often more importantly are other things going on in the knee that may affect recovery after surgery. I usually promise patients that the tear will be gone with surgery completely….. but will they be better? That is the better question to ask: Will my knee pain be gone?? IF its all from the tear then YES, but if there are other factors at play, it might be NO. This is why a good conversation with your surgeon is important to understand the overall condition of the knee and factors that may affect outcomes after surgery. Treatment is more than just reading the MRI – its treating the whole patient and all the factors in the knee. While it’s hard to give you sound medical advice without seeing you, after 3 months I’d likely be thinking about an arthroscopic surgery to take care of the tear. Hope this helps. All the best,
I injured my knee the end of October, unfortunately I’m not a pro football player and worked in a brace for 2 months .
I found a great doctor in Vegas where I was working who found a medial meniscus tear and mcl tear he ordered an OA Nano brace fitted for me that I received 2 weeks ago.
On Dec 15th I was able to stop working and give it time to heal, but I’m the knee is still pretty painful even when sitting still and constantly popping when I bend or straighten it, I’m concerned that I may have done more damage working on it for 2 months after the MRI, and now that I am back home in Phoenix I am looking for a new Ortho. do you have anyone that you recommend?
It may surprise you that the real question is ‘what is causing the pain’? Its likely the meniscus, but cartilage damage may also be a big part of it, especially if the brace is helping. Many patients are in your situation – Please reach out to me by email for a few referral options in the area – Each knee is so unique and your surgeon needs to look over your MRI scan and xrays as well to help find the best option for you. Best wishes.
Good afternoon Dr. Hacker,
I was wondering if by looking at an MRI a doctor can determine how long a horizontal meniscus tear could have occurred. I was in the Marine Corps and we ran 3 1/2 miles daily not to mention very packs and humps. I had pain during service and current and when i went to have an MRI years later because I was to proud to complain they found bilateral horizontal tears almost identical in both knees however because i only went to complain during service about the left knee they denied my right knee.
Hi Camila – It can be tough to determine chronicity from and MRI scan itself – there is usually more to the story – how long you have had trouble, what other symptoms you may have or not have, and what is causing the pain. Of course, I would have to see you to really understand it all and give you good advice. Remember an MRI is just one piece of the puzzle to determine what is going on with your knee. Be sure to talk in detail with your surgeon about these findings, possible causes, and what the next best step will me.
Waiting on mri results right now. Something is definitely wrong. Squishy lump on outside mid knee and now one on inside of knee. Knee problem began end of January as I was running on uneven packed snow trail. Knee often feels off especially if I do a lot of twisting and turning in my house. Seems off. Cracks often. Mild arthritis was seen on X-ray. I am 50 years old. A runner. Most days it doesn’t bother me, but then if movements are off it messes up. Concerned.
Hi Tammy – Sounds like you are doing the right thing getting the scan. Remember it takes more than an MRI to determine what is going on and what the best treatment is – always best to speak directly with your orthopedic surgeon about your knee, have him/her look over your knee, and discuss the MRI findings to determine what the next step will be for you. All the best ! Keep me posted. SH
Hey Doc, I have a question for you? So my right knee has been a issue for a long time, & I just got my MRI Results today & my Doc said the Radiologist said that I have a Significant Meniscus Tear in my knee & quite a bit of fluid in the knee as well! So would I need surgery?
Hi Eric – sorry for the late reply. There are a number of factors that go into determining if you need surgery. Age is important, as well as x-ray findings and any other findings such as cartilage damage. In many cases, if you continue to have symptoms, surgery is a good idea for meniscus tears as it can be dramatically better. We treat people, not just the scan. i would never suggest surgery just because of imaging findings. Again, cant really give personal medical advice here, but these are good concepts to understand for knee patients.