While our meniscus starts off as a pristine white, “c” shaped structure in our knee … our sports, or a lifetime of micro-trauma can take its toll. The end result is a meniscus tear. Not all meniscus tears are the same. They do not look the same. They were not all caused by the same trauma. And most important of all… not all meniscus tears should be treated the same. Having an understanding of the different types of meniscus tears will help you understand what treatment if any is necessary to improve your knee pain.
Types of meniscus tears — Trauma or no trauma?
Meniscus tears come in many different shapes and sizes. The various types of meniscus tears you could have will dictate whether or not you may need surgery. The various types of meniscus tears will also determine whether or not the torn piece can be stitched or repaired, or whether the torn piece will simply need to be removed. The type of meniscus tear you have will also determine whether or not you will likely have persistent pain on an ongoing basis or whether or not you can expect to feel better after a period of rest.
First there are acute or traumatic meniscus tears that occur as a result of an injury. Next, there are degenerative meniscus tears which occur as a result of wear and tear or attrition, and usually are not preceded by trauma . Traumatic meniscus tears come in all sorts of shapes and sizes. There are radial tears, which are short tears that extend from the inner margin of the meniscus and head towards the periphery or outer part of the meniscus. There is a picture below of a radial tear. There are also horizontal cleavage tears. These are very common and literally cleave a big portion of the meniscus in half, so there are nearly two “c” shaped discs sitting on top of one another. The largest of all meniscus tears is a bucket handle tear. Think of a bucket handle. You can flip it from one side of the bucket to the other. The same thing occurs inside the knee. The entire meniscus tears, and the entire c shaped disc flips over and sits in front of the knee. The picture below shows a bucket handle tear where the entire meniscus is sitting in front of the femur.
Types of meniscus tears: Unstable versus stable
Similar to how the type of meniscus tear can determine whether or not your tear is repairable — The various types of meniscus tears we have will determine how much the meniscus tear will bother you. In general, large unstable tears (radial tears, flap tears and bucket handle tears) tend to remain bothersome, whereas degenerative tears typically do not produce significant ongoing discomfort. When you look at a degenerative tear, the edges are simply frayed. The tissue has been worn out from years and years of use. Nothing you did wrong. The tissue simply wore out. Again, like my analogy with the rotator cuff, it’s like the front of a pair of blue jeans that you’ve worn for decades and the material just simply wore out. Then there are those who have one of the other acute tears we discussed. The size, shape and type of meniscus tear will determine whether or not the meniscus tear is “stable” or “unstable” — and thus help us determine whether or not your pain will improve or persist. If a loose flap of tissue is created and that flap is moving around within the knee—that’s when you’re going to have giving way and you’re going to have pain with many activities. You’re not going to tolerate meniscus flap tears well and those patients with meniscus flap tears (or unstable meniscus tears) will usually (not always) go on to require an arthroscopy or a scope to try to either repair or remove that torn piece.
Most people with degenerative meniscus tears may have one or two exacerbations or periods during the year where their knee hurts — but, by and large they get around just fine and lead very active lifestyles with these degenerative tears and do not require surgery ( arthroscopy ) for treatment of those tears.
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