knee pain, Meniscus Tear ,types- Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes knee pain, types of meniscus tears.
It also explains about knee pain examination of the meniscus. Knee pain diagnosis and knee pain treatment .It describes knee injury meniscus tear, meniscus pain, meniscus tear symptoms .it also describes meniscus tear tests and meniscus tear surgery
- The first type is called: Vertical Longitudinal Tear, you can see in the diagram hoe it will look like, this is the tear that probably will need repair, peripheral tear is vascular and probably will need repair.
Tears in the peripheral 25%, in the red zone will heal, the smaller the rim width of the tear, the better the healing.
This longitudinal or peripheral tear is the type you see with ACL tear, and also you can see it with tibial plateau fractures.
- Another peripheral tear type called: Incomplete Longitudinal or Peripheral tear, it doesn’t go through the entire meniscus it goes through part of the thickness of the meniscus.
- The vertical or peripheral tear are called bucket handle tear when they are complete and unstable.
Complete tears are usually longer that 1 cm, will usually displace into the joint and causes mechanical symptoms, possibly block of extension, and it’s called: locked knee.
How do you know the locked knee of this patient is from a meniscal tear?
You will be able to tell that from the history and examination of the patient.
If you have a history of an injury and you have a joint line tenderness and some effusion, the patient probably has a meniscal tear.
So we got: 1- complete longitudinal peripheral vertical tear. 2- The bucket handle.
3- The displaced bucket handle: In the medial side that can give you the double PCL sign.
Double PCL sign on MRI is 100% specific for a bucket handle meniscal tear.
You can also see it on the MRI as fragment on the notch sign because one fragment is displaced, or you can see absent bow tie sign.
In the other type it’s called Parrot Beak tear, this is an oblique tear, and they are a group of types:
- Peripheral tears: 1- incomplete longitudinal tear, 2- complete longitudinal tear, 3- bucket handle tear, 4- displaced bucket handle tear.
- Oblique tears: 1- parrot beak tear, 2- flap tear, 3- displaced flap tear.
Parrot Beak occur at the junction of the posterior horn and the body of the meniscus, it can cause mechanical symptoms and the treatment is usually partial excision to stable them, because you can’t repair them.
If the tear is bigger it could be a flap then it can be a displaced flap that causes mechanical symptoms.
We have seen the Peripheral tear, the Oblique tear, now we will see the Radial tear:
The Radial tear can’t be repaired, and in this case we lost the circumferential fiber integrity, it usually starts centrally and proceeds peripherally, it can lead to a flap tear or double flap tear.
The Horizontal Cleavage Tear: occurs more in the older population and may be associated with the meniscal cyst.
Complex tear: means the combination of all these types and it usually occur in the older population.
Why do we look at the types?
Because some of them may be repairable if they are peripheral tears.
Some of them may cause mechanical symptoms, such as displaced bucket handle tear.
Some of them may not be repaired at all, they may need just trimming or partial excision to stabilize them, like the radial tear, or the flap tear.
Some of them may have meniscal cyst like the horizontal cleavage tear.
Some of them may be complex degenerative tears as in older population and arthritis, and they may want to start treating that conservatively.
So knowing the type of the tear may help you in planning your treatment.
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