A horizontal cleavage tear is a degenerative tear of a meniscus, extending into the meniscus substance, and cleaving it horizontally into two parts, like a clam.

horizontal cleavage tear

The horizontal tear is a shearing injury. It is revealed by probing of the meniscus.

meniscal cyst originating from a horizontal cleavage tear of the meniscus

A meniscal cyst may form in the joint line if fluid is forced through the cleavage by a valve-like action.

horizontal cleavage tear

 

Probing a trimmed horizontal cleavage tear during an arthroscopy

 

Horizontal cleavage tears and meniscal cysts

The clam-like nature of such a meniscus tear may allow fluid to be forced out into the tissues on the side of the joint, forming a meniscal cysts - a tender palpable fluid-filled lump in the joint line.

 

Management of horizontal cleavage tears

These tears are difficult to manage. Surgeons will often choose a partial meniscectomy or even a total meniscectomy, preserving what they can of the rim. Repair might be attempted after roughening up the inside of the tear, pushing a lump of blood clot (from the patient) into the defect, and suturing it in place.

Synonyms: 
Horizontal tear
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Meniscal cyst

Article explaining how meniscal cysts form and how they are diagnosed and treated.

How the surgeon decides on management.

Types of meniscus tear

Illustrations of the types of tear one might see in the meniscus.

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CLINICAL PUBLICATIONS

Repair of isolated horizontal meniscal tears with all-inside suture materials using the overlock method: outcome study with a minimum 2-year follow-up. Tiftikçi U and Serbest S. J Orthop Surg Res. 2016; 11: 131.

Horizontal Cleavage Meniscus Tear Treated With All-inside Circumferential Compression Stitches. Woodmass JM, Johnson JD, Wu IT, Saris DBF, Stuart MJ and Krych AJ. Arthrosc Tech. 2017 Aug; 6(4): e1329–e1333.

Surgical management of degenerative meniscus lesions: the 2016 ESSKA meniscus consensus. Beaufils P, Becker R, Kopf S, Englund M, Verdonk R, Ollivier M and Seil R. Knee Surg Sports Traumatol Arthrosc. 2017; 25(2): 335–346.


 

See also -


 

Video courtesy of Dr Ram Venkatesh


 

eBook about meniscus injuries

Knee Meniscus Injury - ebook


 

eBook on managing meniscal injuries

Managing Meniscal Injuries - ebook