Types Of Meniscus Tears And Their Impact On Mobility

Meniscus tears are injuries to the rubbery cartilage in the knee that acts as a shock absorber between the thigh and shin bones. They often occur due to sudden twists or impacts or age-related degeneration. They commonly affect athletes, active individuals, and aging adults. 

While surgery is a common treatment, about half of meniscal tears occur in the areas of the menisci with a blood supply. Tears in these regions can heal naturally. 

Procedures using Regenexx injectates utilize interventional orthobiologics to support the body’s natural healing ability. This approach offers an alternative path to recovery, reducing the need for surgery or prescription medications.

Understanding Meniscus Tears

The meniscus is a piece of cartilage located between the thigh bone (femur) and shinbone (tibia) in the knee joint. Each knee has two menisci, which absorb shock, reduce friction, and improve knee stability by distributing weight. Tears in the meniscus can cause pain and restrict mobility. 

Meniscus tears are one of the most common knee problems. They are estimated to affect around 14% of the general population. They are commonly caused by twists, rapid changes of direction, or pivoting movements. However, they can also occur due to traumatic injuries, such as being involved in a car accident or due to the age-related degeneration of the cartilage. 

Recognizing Symptoms

Meniscus tear symptoms vary depending on the severity of the injury. In the case of mild tears, patients may not have any symptoms at all. One study estimates that over 60% of the subjects with meniscus tears examined did not experience any pain, stiffness, or aching. 

However, with more severe tears, symptoms can range from mild discomfort to acute pain and knee instability. Patients with a meniscus tear may notice:

• Knee pain. Pain may occur when the torn meniscus disrupts smooth knee movements. It typically occurs along the joint line and worsens when bearing weight or engaging in knee flexing.
• Swelling. The body’s natural response to the torn tissue is to send extra blood and fluids to the site for healing. This leads to fluid accumulation and swelling.
• Stiffness. Stiffness occurs because pain and swelling interfere with movement. The damaged meniscus may also prevent smooth knee movements. Stiffness can make common activities like walking or bending the knee challenging.
• Popping sensation. A popping sensation often occurs at the moment of injury when the meniscus tears. This is due to the sudden rupture of cartilage fibers, creating an audible sound. After the injury, noises like popping and grinding can also occur. This symptom is known as crepitus.
• Locking. Knee locking happens when a piece of the torn meniscus becomes lodged in the knee joint. This obstruction prevents normal movement, locking the knee in one position. Patients may also struggle to bend or fully straighten the leg. 
• Instability. Instability occurs when the torn meniscus fails to provide support and stability to the knee. Patients may feel that the knee will “give out” during daily or sports activities. 

Causes Of Meniscus Tears

There are two main categories of meniscus tears, each with its causes:

• Acute. These result from sudden, forceful movements or traumatic injuries that place excessive force on the knee. They typically occur during sports requiring quick pivots or stops, such as basketball or football. Other causes include car accidents and direct contact injuries. 
• Degenerative. These result from gradual wear and tear. Aging is the main cause of degenerative tears, as it causes the cartilage to weaken and become more susceptible to tears. However, activities that repeatedly stress the knee, like squatting or climbing stairs, can speed up cartilage breakdown. Other risk factors include smoking, a sedentary lifestyle, and conditions like obesity and arthritis. 

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What Are The Meniscus Tear Types?

Each knee has two C-shaped menisci:

• Medial meniscus: Located on the inner side of the knee. It is larger and more prone to injury.
• Lateral meniscus: Found on the outer side. It is more circular and absorbs less stress than the medial meniscus.

Meniscus tears are categorized based on several factors: 

• Location:
  • Anterior: Front part of the meniscus.
  • Middle: Central area.
  • Posterior: Back section of the meniscus.

• Shape:
  • Longitudinal: Parallel to the edge of the meniscus.
  • Radial or transverse: Perpendicular to the meniscus’s curve.
  • Horizontal: Splits the meniscus into upper and lower sections.
  • Oblique: Diagonal tear.

• Severity:
  • Partial or incomplete tear.
  • Complete tear or rupture.

• Stability:
  • Stable tear: Meniscus pieces remain in place.
  • Unstable tear: Meniscus pieces move around and may require surgical intervention.

Meniscus tears can occur in one of the three zones of the meniscus:

• Red or vascular zone: This zone is located on the outer edge of the meniscus. It has a rich blood supply. Tears in the zone can heal naturally. 
• Red-white zone: This zone is in the middle of the meniscus and has less blood supply. Tears in this section may heal naturally, but recovery may be slower. 
• White or avascular zone: This is the inner part of the meniscus and lacks blood supply. Tears in this section are least likely to heal on their own and may need more complex treatments.

Differences in these categories determine the treatment approach. For instance, stable tears in the red zone often heal with rest and physical therapy. Unstable or complex tears may need additional intervention. 

1. Intrasubstance (Incomplete) Tear

An intrasubstance tear is an incomplete tear that affects the internal fibers of the meniscus. It does not usually extend to the surface. These tears are often found in the medial meniscus. They usually occur due to degeneration, especially in older adults.

Typical symptoms include mild pain along the knee joint, swelling, tenderness, and stiffness. Although they might not cause significant symptoms initially, these tears can progress into more severe tears if left untreated.

2. Radial (Transverse) Tear 

Radial tears, or transverse tears, often occur in the posterior horn of the meniscus. These tears extend perpendicularly to the cartilage fibers. They tend to run from the inner edge towards the outer rim. This can disrupt the ability of the meniscus to distribute weight.

Symptoms include sharp pain at the time of injury, usually accompanied by an audible pop. Patients also experience significant swelling and difficulty with movements or bearing weights. Radial tears can lead to severe knee instability. They may also increase the risk of further injury due to their impact on the knee’s ability to absorb shocks. 

3. Horizontal (Longitudinal) Tear

Horizontal or longitudinal tears split the meniscus into top and bottom sections. They usually run along the body of the meniscus. These tears are often the result of repeated stress and degeneration in older adults. They can also happen due to acute trauma in younger or active individuals.

Symptoms include chronic knee pain, which intensifies during movement, and a sensation of knee locking. Patients also experience swelling, limited range of motion and knee instability. 

A common complication of degenerative horizontal tears is the formation of meniscal cysts. These develop when the surrounding synovial fluid leaks into the tear. 

Meniscus cysts are often treated with partial meniscectomy, a surgical intervention used to remove part of the meniscus. However, a study showed that finding the lesion during surgery can be difficult, making a larger-scale surgery necessary. This increases the risk of complications, including postoperative osteoarthritis.

4. Flap Tear 

Flap tears are also known as parrot beak tears. They occur when a portion of the meniscus becomes loose and displaced, forming a flap resembling a parrot’s beak. These tears often happen in the posterior horn of the meniscus, commonly due to sports injuries or direct trauma.

The flap causes irregularities on the meniscus’s surface, affecting movement and knee function. Symptoms can be severe, including pain, instability, knee locking, and catching sensations. Pain tends to intensify when bending or straightening the knee. 

Flap tears affect the mechanics of the knee joint. Over time, this can make movement unpredictable and stress other joint components, leading to chronic pain and further damage.

5. Complex Tear

A complex tear involves multiple types of tears within the meniscus. They usually occur from severe trauma or advanced degeneration. These tears can affect various locations within the meniscus, making them difficult to treat.

Symptoms depend on the types of tears involved but usually include:

• Diffuse knee pain, which can affect a larger area
• Persistent swelling
• Limited range of motion
• Knee instability and frequent locking
• Deterioration of knee function

6. Bucket-Handle Tear

A bucket-handle tear is a severe type of injury where a portion of the meniscus tears and flips into the joint, forming a shape like a bucket handle. It commonly affects the medial meniscus and is frequently associated with sports injuries. Bucket-handle tears account for around a third of meniscus tears.

Symptoms include severe joint pain, immediate swelling, and locking or catching sensations. Patients also experience knee instability, audible clicking sounds, and inability to extend the knee fully. 

Diagnosing A Torn Meniscus

Early and accurate diagnosis is essential to determine the type and severity of the tear. A physician will use a combination of diagnostic tools to assess the injury and guide treatment decisions. These may include:

• Physical examination
  • McMurray Test. The physician bends, straightens, and rotates the knee to assess a range of motion. They will also look for signs that indicate a tear, like clicking sounds.
  • Apley Grind Test. The physician compresses and rotates the knee while the patient lies on their stomach. This method is used to check for pain and grinding sounds.
  • Thessaly test: During this test, the patient will stand on the injured leg. The unaffected leg will be lifted off the floor and slightly bend backward. Then holding onto the physician’s arms for support, the patient will rotate the torso side-to-side, which will require the support of the knee. The physician then checks for pain or a catching sensation, which may indicate a meniscal tear.

• Imaging tests
  • Magnetic resonance imaging (MRI). An MRI provides detailed images of the knee’s soft tissues, including the meniscus. These tests help identify the tear’s location, pattern, and extent.
  • X-rays. These can’t directly visualize the meniscus. However, they are useful in ruling out other causes of knee pain that affect hard tissues, such as bone fractures.
  • Ultrasound. This imaging technique uses sound waves to provide real-time images of the knee. It is particularly useful for visualizing soft tissues like the meniscus. Ultrasound helps detect tears, assess the injury’s extent, and guide treatment decisions. Additionally, it offers a dynamic view, allowing the physician to observe the knee during motion.

• Diagnostic arthroscopy 
  • This is a surgical procedure where a small camera is inserted into the knee joint via small incisions. This allows direct visualization of the meniscus and any potential tears. It carries some of the risks associated with surgery, including infection. 

Regenexx Non-Surgical Approach For Knee Pain

Patients often undergo surgery for a torn meniscus, yet it’s not always necessary. As noted above, the meniscus has different zones. Some of these have a rich blood supply, which supports natural healing. One study found that around 41.3% of tears occur in the red zone and 21.8% occur in the red-white zone. 

Procedures using Regenexx injectates help harness the body’s natural healing ability. Using interventional orthobiologics, the Regenexx approach offers patients an alternative path to recovery, reducing the need for surgery or prescription medication. Customized treatment plans may include one or more of the orthobiologics below. 

Regenexx-SD Injectate

Procedures using Regenexx-SD injectate include a patented protocol that utilizes Bone Marrow Concentrate (BMC), which contains the patient’s own mesenchymal stem cells. The cell processing for a Regenexx-SD injectate routinely achieves 20x concentration— above what non-Regenexx cell processing can achieve.

Regenexx-SCP Injectate

Procedures using Regenexx-SCP injectate represent a supercharged version of platelet-rich plasma (PRP). In this process, blood is drawn then processed to isolate the platelets and growth factors. The growth factors are then purified, concentrated, and injected into the knee using imaging guidance for precision. Regenexx-SCP injectate provides a higher concentration of growth factors compared to typical PRP procedures.

Explore Your Torn Meniscus Treatment Options Beyond Surgery 

The Regenexx approach provides a non-surgical path for those suffering from torn meniscus pain. It also reduces the need for prescription medications. Regenexx offers an alternative to traditional surgical approaches, which may help individuals reduce pain and support improved mobility with minimal downtime.

Learn how a physician in the licensed Regenexx network can help determine if Regenexx is right for you.

Originally published on Mar 14, 2025