Ross Hauser, MD

In this article, we provide background information on the many types of meniscus tears and how they can be treated with a non-surgical Comprehensive Prolotherapy approach.

• If you have questions about your meniscus injury, get help and information from our Caring Medical staff

For Caring Medical non-surgical treatment guidelines please see Non-surgical Meniscus Repair-procedures.

The many types of meniscus tears

From the National Institutes of Health NIH

Menisci have two zones. The red zone is outside and the white zone is inside. Meniscus tears are characterized by their placement in these two zones.

The categorizing meniscus injury into the red and white zone would also help surgeons identify which injury could heal by itself and which could not.

A red zone tear lies within the blood-rich portion of the meniscus. Where there is a blood supply there is healing as blood brings the healing and growth factors needed for wound repair. The white zone meniscal tear is was thought to be non-healing because there is no direct blood supply.

If meniscal tears could keep themselves contained to a zone – healing would be easiest -however, meniscus tears can transverse the red and white, the healing and non-healing zones. The key to many doctors is to heal the white zone tears and you can non-surgically repair a meniscal injury.

• In new research doctors in China released their findings on white zone meniscal tears in rabbits and the introduction of stem cells into the injury. The results showed that stem cells could promote white zone healing.1

The other classification of the meniscus tear is related to the depth of the tear.

• Tears are considered to either be partial thickness tears or full thickness tears.
• Partial thickness tears are tears that only extend part way across the meniscus, while full thickness tears extend fully across. So, if you have a full thickness flap tear, then it is a tear that cuts across the meniscus completely.

Meniscus bucket handle tear

• The meniscus bucket handle tear is a tear that tears vertically in either zone. It does not cut across the meniscus, but rather tears so that the curve looks like a bucket handle. Sometimes a bucket handle tear will turn into a “flipped meniscus” where the meniscus fragment folds backward.
  • In new research, doctors presented a case study where three Platelet Rich Plasma Therapy treatments were able to completely repair a bucket handle meniscus tear 7 months after diagnosis of injury.2
  • Doctors at New York University’s Langone Medical Center investigated the failure rate for surgically repaired bucket-handle meniscus tears at a minimum 2-year follow-up interval. Reporting in the medical journal the Physician and Sports Medicine May 2017, the doctors looked at 51 patients who experienced bucket-handle meniscus tears that were isolated or occurred with an ACL injury. Of the 51 patients that had a bucket-handle meniscal repair, 12 (23.5%) were defined as failures.3

Other Meniscus Tears

• A transverse tear (radial tear), is a tear that extends across both zones, starting at the red zone and then extending downward into the white zone.
• A horizontal tear (or flap tear) is the exact opposite of a longitudinal tear; it cuts across the meniscus, as opposed to running alongside it.
• An oblique tear is a tear that is diagonal across the meniscus. When any of these patterns combine it is called a complex tear.
• Complex meniscal tears are just that – a combination of tears that are “complex.” Sometimes you may get a diagnosis of a macerated meniscus, meaning shredded, frayed, or ripped up.
• Oblique tear or parrot beak tears because as they get larger they make an open, angular shape that looks like a bird’s beak.
• Your MRI report may include tags such as:
  • Posterior (back) horn medial meniscus tear,
  • radial tear of medial meniscus,
  • horizontal medial meniscus tear,
  • complex medial meniscal tear.
  • meniscal root tear

Treating the meniscus

Meniscus tears will eventually lead to degenerative arthritis. Determine the underlying cause of the weakness and instability; stop the degenerative process with regenerative injection treatments and you can halt the progression of arthritis.

Regardless of the diagnosis – meniscus repair should be holistic – the whole knee should be treated with Prolotherapy to strengthen instability issues. Meniscal tears are never isolated. Any injury affects all the structures of the joint. Surgery can only address a specific structure, comprehensive Prolotherapy to the Meniscus including stem cells and blood platelets seeks to achieve healing of the whole knee.

Comprehensive Prolotherapy is a viable alternative to knee surgery for meniscus tears.

If you have questions about your meniscus injury, get help and information from our Caring Medical staff

1. Huang H, Wang S, Gui J, Shen H. A study to identify and characterize the stem/progenitor cell in rabbit meniscus. Cytotechnology. 2016 Oct;68(5):2083-103.
2. Urzen JM, Fullerton BD. Nonsurgical Resolution of a Bucket Handle Meniscal Tear: A Case Report. PM R2016 Jun 6. pii: S1934-1482(16)30158-7.
3.  Moses MJ, Wang DE, Weinberg M, Strauss EJ. Clinical outcomes following surgically repaired bucket-handle meniscus tears. Phys Sportsmed. 2017 May 16.

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