Meniscus tear in the knee

A meniscus tear is a very common knee injury that causes pain in the knee joint.

The knee has two menisci that lie between the thigh bone (femur) and the shin bone (tibia).
They are made of fibrocartilage and their crescent shape conforms to the articular surface of the tibia.
The medial meniscus (internal meniscus) is on the inside of the knee, and the lateral meniscus (external meniscus) is on the outside.

Injuries to the medial meniscus are much more common because they are less mobile; abrupt knee movement can overstretch this medial meniscus, causing an injury.
Meniscus injuries are becoming more common; anyone can be affected, but athletes who play contact sports are more likely to have it, especially soccer players.
Preventing meniscal fissures is extremely difficult, and strengthening your knee muscles is the only way to reduce the risk.


What is meniscus degeneration?

Meniscus damage can also   result from wear and tear and lead to degenerative changes, just like osteoarthritis of the joints; this pathology occurs mainly in the elderly and adults and is characterized by a slow abrasion of the fibrocartilage, even in the absence of direct or indirect trauma . The symptoms of meniscal degeneration are pain in the last phase of squatting and when walking or running.

Which part of the meniscus is damaged?

There are different types of meniscus injuries. The correct diagnosis is extremely important, because only certain lesions can be treated surgically.
The tear is more common in the posterior horn of the medial meniscus, while the injury is less common in the anterior horn of the medial meniscus.

Zerfaserter Rand

The meniscus damage can simply consist of a fraying of the edge.
The surgeon can remove the damaged rim and hope that the wear affects only a small portion of the meniscus.
If the entire meniscus is degenerated, its shock absorbing function is severely impaired; as a result, the cartilage on the femur and tibia is extremely stressed. In this case , early arthrosis can develop.

Radiary rash

The radial tear begins at the inner rim of the meniscus and then fully or partially traverses it. This type of lesion often occurs on the lateral (outer) meniscus.
Transverse tears are probably one of the most common types of meniscus damage.
If the radial crack is very small, it will be difficult to see; when it gets bigger and represents a complete rupture, also called a flap tear, it looks like a piece of the meniscus is missing.

Lappenriss (Flap)

For untreated radial tears, usually transverse tears, the body can attempt to heal itself by forming a flap.
This part of the meniscus can protrude into the joint space.

Over time, a flap can develop and cause joint lock during movement. A flap tear can be caused by trauma , repetitive strain, or heavy physical activity, and often occurs in combination with other lesions.
You can repair this damage with a stitch. The inner area cannot heal because of the low blood supply, so the surgeon will remove part of the meniscus.
The healing of the outer area is crucial because it plays a more important role for the knee.
The radial meniscus lesion often occurs in combination with the anterior cruciate ligament tear .

longitudinal crack

A longitudinal tear runs longitudinally to the direction of travel of the collagen fibers, which are aligned parallel to the meniscus rim. This type of injury divides the meniscus into an inner and an outer area.
The edge of the meniscus is usually not affected here. This tear is medial rather than lateral in nature and is caused by repetitive movements.
The lesion often begins with tearing of the posterior horn and may heal on its own.


If a longitudinal tear does not heal properly, it can develop into a basket handle tear.
This is a complete tear that runs from the top to the bottom surface but does not touch the inner edge of the meniscus.
There is a risk that the basket handle will roll over and cause the knee to stretch.

This type of injury accounts for 10% of all meniscal lesions and results in knee lock on flexion. Young athletes are often affected; it occurs in 50% of anterior cruciate ligament injuries.


A horizontal tear starts in the deep part of the meniscus and divides it into an upper and lower part (like a sliced ​​bun).
It is often not visible and shifts from the posterior horn or midsection to the interior of the meniscus.

Horizontal tears are rare, occurring after minor rotational trauma or due to degeneration.
This injury primarily affects the lateral meniscus, but it can occur in both menisci.

A horizontal split fracture can occur if the tear is not treated.
The tear runs horizontally on the meniscal surface and forms a tongue that folds over with movement of the knee and makes a snapping sound when the patient tries to bend the leg; you can think of it as if the meniscus were sliced ​​in two and a piece of the top section separates and turns over, much like an open book.

This injury is the result of a strong impact that damages the meniscus from the inside; itself can easily become a complex lesion if left untreated.

What can you do? How can a horizontal crack be treated?

The surgeon removes the tongue during the procedure to prevent further tears.
If the outer area of ​​the meniscus is still intact and there is still sufficient fibrocartilage, the meniscus can continue to exert its shock absorbing function after the operation.
If this tear spreads from the top of the meniscus to its outer edge, a cyst (a cavity on the outer edge of the meniscus that collects synovial fluid) can form there.

Read more