A radial tear of the meniscus cuts across the main fibres of the meniscus, from the inner rim to the outer rim.
Page updated February 2024 by Dr Sheila Strover (Clinical Editor)
A radial tear of the meniscus cuts across the main fibre bundles, and there is poor healing.
A cross-section of a meniscus, showing how the stronger fibre bundles run circumferentially around the meniscus. It also shows that the blood supply is greater on the outer rim, while the inner rim has virtually no blood supply.
Why do radial tears heal poorly?
With each step the radial tear can open up. Also the cutting of the fibres interrupts the hoop forces that normally displace the pressures to the outer edge of the meniscus.
-
Quote from peer-reviewed paper:
"...Radial tears....[are]....ugly lesions, because [they] create unfavourable knee dynamic contact mechanics that are not significantly different from those resulting from meniscectomy....[But] the focus on preservation of meniscal tissue has become increasingly imperative even in this context...."
Citation: Simonetta R, Russo A, Palco M, Costa GG, Mariani PP. Meniscus tears treatment: The good, the bad and the ugly-patterns classification and practical guide. World J Orthop. 2023 Apr 18;14(4):171-185. doi: 10.5312/wjo.v14.i4.171. PMID: 37155506; PMCID: PMC10122773.
Management of radial tears
Usually the clinician will attempt a period of 'conservative' treatment, ie avoiding surgery but focusing on activity modification, pain-killers, anti-inflammatory medication and strengthening the muscles around the knee. An unloader brace may be useful to take load off the damaged side.
If the patient is still symptomatic after 3-6 months, then surgery is likely to involve a partial meniscectomy of the non-vascular inner rim, and perhaps an attempt at meniscal repair augmented by blood clot.
-
Quote from peer-reviewed paper:
"....Acute traumatic tears should always preferably be repaired, while repair indication in chronic degenerative tears will depend on meniscal tissue quality and accompanying degenerative changes in the joint...."
Citation: Mameri ES, Jackson GR, Gonzalez F, Kaplan DJ, Jawanda H, Batra A, Khan ZA, Chahla J. Meniscus Radial Tears: Current Concepts on Management and Repair Techniques. Curr Rev Musculoskelet Med. 2023 May;16(5):182-191. doi: 10.1007/s12178-023-09831-5. Epub 2023 May 9. PMID: 37157051; PMCID: PMC10188782.
-
Quote from peer-reviewed paper:
"....a recent systematic review demonstrated that a combination of all-inside horizontal or crossed stitches reinforced with suture parallel to the tear as ripstop (defined as hashtag or crosstag technique, respectively) may improve the repair strength"
Citation: Simonetta R, Russo A, Palco M, Costa GG, Mariani PP. Meniscus tears treatment: The good, the bad and the ugly-patterns classification and practical guide. World J Orthop. 2023 Apr 18;14(4):171-185. doi: 10.5312/wjo.v14.i4.171. PMID: 37155506; PMCID: PMC10122773.
Forum discussions
- Advice Needed...Just been told I have the following Tear..
Patients struggling to understand the implications of different types of meniscus tear.
Types of meniscal tear -
- Meniscus
- Longitudinal tear
- Bucket-handle tear
- Horizontal cleavage tear
- Parrot-beak tear
- Flap tear
- Ramp lesion
Peer-reviewed paper -
- 2020 - Management of traumatic meniscus tears: the 2019 ESSKA meniscus consensus. Authors: Kopf S et al. - summarised for KNEEguru readers by Dr Sheila Strover (Clinical Editor)
