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Meniscal tears are among the most common intra-articular knee injuries, affecting the medial or lateral meniscus of the knee joint. They may result from trauma, degeneration, or sports-related injuries and are best evaluated with MRI.

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https://www.youtube.com/watch?v=QviesmjU8Q0

Anatomy

![(A) Normal anatomy of the menisci, with the C-shaped medial meniscus and O-shaped lateral meniscus, and the inter-meniscal ligament (i.e., “transverse intermeniscal ligament”) anteriorly and menisci roots attachment onto the tibial posteriorly along with ligaments attaching to the posterior cruciate ligament (Ligament of Wrisberg posteriorly, and Ligament of Humphrey anteriorly—not shown). (B) Axial view of a right tibial plateau showing sections of the meniscus and their relationship to the cruciate ligaments. AL, anterior horn lateral meniscus; AM, anterior horn medial meniscus; PCL, posterior cruciate ligament; PL, posterior horn lateral meniscus; PM, posterior horn medial meniscus.

A: Greis PE, Bardana DD, Holmstrom MC, Burks RT. J Am Acad Orthop Surg. 2002, 10, 168–176; original from Pagnani MJ, Warren RF, Arnoczky SP, Wickiewicz T. The Lower Extremity and Spine in Sports Medicine. 1995, p 581–614, © Mosby. B: Johnson RJ, Kettelkamp DB, Clark W, Leaverton P. J Bone Joint Surg Am, 1974, 56, 719–729).](attachment:6f2a399a-e3b9-4c9d-bcf9-ac67ab887757:ca22456-fig-0003-m.jpg)

(A) Normal anatomy of the menisci, with the C-shaped medial meniscus and O-shaped lateral meniscus, and the inter-meniscal ligament (i.e., “transverse intermeniscal ligament”) anteriorly and menisci roots attachment onto the tibial posteriorly along with ligaments attaching to the posterior cruciate ligament (Ligament of Wrisberg posteriorly, and Ligament of Humphrey anteriorly—not shown). (B) Axial view of a right tibial plateau showing sections of the meniscus and their relationship to the cruciate ligaments. AL, anterior horn lateral meniscus; AM, anterior horn medial meniscus; PCL, posterior cruciate ligament; PL, posterior horn lateral meniscus; PM, posterior horn medial meniscus.

A: Greis PE, Bardana DD, Holmstrom MC, Burks RT. J Am Acad Orthop Surg. 2002, 10, 168–176; original from Pagnani MJ, Warren RF, Arnoczky SP, Wickiewicz T. The Lower Extremity and Spine in Sports Medicine. 1995, p 581–614, © Mosby. B: Johnson RJ, Kettelkamp DB, Clark W, Leaverton P. J Bone Joint Surg Am, 1974, 56, 719–729).

![Anatomical photographs of tibial plateau demonstrating the relative size and attachments of the medial and lateral menisci. (A) Superior view. (B) Posterior view.

ACL, anterior cruciate ligament; LPRA, lateral meniscus posterior horn attachment; MPRA, medial meniscus posterior horn attachment; PCL, posterior cruciate ligament; SWF, shiny white fibers of posterior horn of medial meniscus. Johannsen AM, Civitarese DM, Padalecki JR, Goldsmith MT, Wijdicks CA, LaPrade RF. Am J Sports Med, 2012, 40, 2342–2347)](attachment:5a9c8332-4b74-4208-af70-4c255898a8d5:ca22456-fig-0002-m.jpg)

Anatomical photographs of tibial plateau demonstrating the relative size and attachments of the medial and lateral menisci. (A) Superior view. (B) Posterior view.

ACL, anterior cruciate ligament; LPRA, lateral meniscus posterior horn attachment; MPRA, medial meniscus posterior horn attachment; PCL, posterior cruciate ligament; SWF, shiny white fibers of posterior horn of medial meniscus. Johannsen AM, Civitarese DM, Padalecki JR, Goldsmith MT, Wijdicks CA, LaPrade RF. Am J Sports Med, 2012, 40, 2342–2347)

Classification of meniscal tears

• Most common type: Medial meniscus vertical longitudinal tear
• Most common site: Posterior horn of medial meniscus

Common types of meniscal tears (A and B) and; (C) depth of meniscal tears. Hauser RA, Philips HJ, Maddela HS. J Prolother, 2010, 2, 416–437.

![Patterns of meniscus tears; note that vertical tears are also known as longitudinal vertical tears; bucket handle tears result from an extensive vertical tear with or without other associated tear patterns.

Shieh, A.; Bastrom, T.; Roocroft, J.; Edmonds, E.W.; Pennock, A.T. Meniscus Tear Patterns in Relation to Skeletal Immaturity: Children Versus Adolescents. Am. J. Sports Med. 2013, 41, 2779–2783. ](attachment:c2089ded-f744-4bb8-85a9-17bfb57f07b7:pathophysiology-30-00044-g003.png)

Patterns of meniscus tears; note that vertical tears are also known as longitudinal vertical tears; bucket handle tears result from an extensive vertical tear with or without other associated tear patterns.

Shieh, A.; Bastrom, T.; Roocroft, J.; Edmonds, E.W.; Pennock, A.T. Meniscus Tear Patterns in Relation to Skeletal Immaturity: Children Versus Adolescents. Am. J. Sports Med. 2013, 41, 2779–2783.

Most common locations:

![Illustration of the most common locations (direction of the green “sectors”) and relative proportions (sizes of the green sectors) of fragments that originate from the medial (left) and lateral (right) menisci. Note the higher frequency of medial meniscal fragments and their most common locations: the posterior intercondylar notch and perimeniscal recess

Park, L.S., Jacobson, J.A., Jamadar, D.A. et al. Posterior horn lateral meniscal tears simulating meniscofemoral ligament attachment in the setting of ACL tear: MRI findings. Skeletal Radiol 36, 399–403 (2007). https://doi.org/10.1007/s00256-006-0257-3](attachment:d470f0ec-3762-4f62-9bb7-b1b105aebaa9:1-s2.0-S2211568417303169-gr10_lrg.jpg)

Illustration of the most common locations (direction of the green “sectors”) and relative proportions (sizes of the green sectors) of fragments that originate from the medial (left) and lateral (right) menisci. Note the higher frequency of medial meniscal fragments and their most common locations: the posterior intercondylar notch and perimeniscal recess

Park, L.S., Jacobson, J.A., Jamadar, D.A. et al. Posterior horn lateral meniscal tears simulating meniscofemoral ligament attachment in the setting of ACL tear: MRI findings. Skeletal Radiol 36, 399–403 (2007). https://doi.org/10.1007/s00256-006-0257-3

Clinical Presentation