A horizontal cleavage tear is a horizontal shearing of the fibres within the interior of the knee meniscus, effectively cleaving it into two parts, like a clam.

Page updated January 2024 by Dr Sheila Strover (Clinical Editor)

horizontal cleavage tear

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

horizontal cleavage tear


Probing a trimmed horizontal cleavage tear during an arthroscopy


How do horizontal cleavage tears happen?

The internal shearing of a horizontal cleavage tear may occur in a normal knee if there is a very strong twisting force, but more often the meniscus is already degenerative from previous trauma, and twisting just makes this worse.

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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.

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Horizontal cleavage tears and meniscal cysts

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.

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.

  • Quote from peer-reviewed paper:

    "...meniscal cysts can be successfully managed arthroscopically with cyst decompression, excision, and/or percutaneous decompression with arthroscopic visualization."

    Citation: Haratian A, Bolia IK, Hasan LK, Fathi A, Solaru S, Homere A, Petrigliano FA, Weber AE. Arthroscopic Management of Meniscal Cysts: A Systematic Review. Orthop Res Rev. 2021 Sep 17;13:123-139. doi: 10.2147/ORR.S321893. PMID: 34557043; PMCID: PMC8455512.

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This video shows the inside of the knee through an arthroscope. The surgeon is probing the horizontal tear of the meniscus to see how deep it is.

Video courtesy of Dr Ram Venkatesh

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Forum discussions

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Horizontal tear

Dr Sheila Strover (Editor)
BSc (Hons), MB BCh, MBA

See biography...