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Musculoskeletal
Diagnosis
Trauma
Knee
Menisci
Meniscus Horizontal Tear
Meniscus Horizontal Tear
Donna G. Blankenbaker, MD, FACR; Andrew Sonin, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Horizontal tear (HT)

              • Synonyms

                • Meniscus fraying (= minimal HT)

              • Definitions

                • Meniscus tear occurring in axial (horizontal) plane, transecting through long axis of meniscus
                • HT is preferred term according to ISAKOS classification system
                • Meniscus red zone: outer 1/3 of meniscus = vascular portion of meniscus
                • Meniscus red-white junction: middle 1/3 of meniscus between peripheral zone and free edge
                • Meniscus white zone: inner 1/3 of meniscus near free edge, nonvascular

              IMAGING

              • General Features

                • CT Findings

                  • MR Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Consider

                                    • Image Interpretation Pearls

                                      • Reporting Tips

                                        Selected References

                                        1. Hoover KB et al: Reliability of meniscus tear description: a study using MRI from the Osteoarthritis Initiative. Rheumatol Int. 40(4):635-41, 2020
                                        2. Matar HE et al: Degenerative meniscal tears of the knee: evaluation and management. Br J Hosp Med (Lond). 80(1):46-50, 2019
                                        3. Amano H et al: Analysis of displacement and deformation of the medial meniscus with a horizontal tear using a three-dimensional computer model. Knee Surg Sports Traumatol Arthrosc. 23(4):1153-60, 2015
                                        4. Arno S et al: Tibiofemoral contact mechanics following a horizontal cleavage lesion in the posterior horn of the medial meniscus. J Orthop Res. 33(4):584-90, 2015
                                        5. Kurzweil PR et al: Repair of horizontal meniscus tears: a systematic review. Arthroscopy. 30(11):1513-9, 2014
                                        6. Nguyen JC et al: MR imaging-based diagnosis and classification of meniscal tears. Radiographics. 34(4):981-99, 2014
                                        7. Davis KW et al: Magnetic resonance imaging and arthroscopic appearance of the menisci of the knee. Clin Sports Med. 32(3):449-75, 2013
                                        8. Kim JR et al: Traumatic and non-traumatic isolated horizontal meniscal tears of the knee in patients less than 40 years of age. Eur J Orthop Surg Traumatol. 23(5):589-93, 2013
                                        9. Pujol N et al: Magnetic resonance imaging is not suitable for interpretation of meniscal status ten years after arthroscopic repair. Int Orthop. 37(12):2371-6, 2013
                                        10. Shieh A et al: Meniscus tear patterns in relation to skeletal immaturity: children versus adolescents. Am J Sports Med. 41(12):2779-83, 2013
                                        11. Yim JH et al: A comparative study of meniscectomy and nonoperative treatment for degenerative horizontal tears of the medial meniscus. Am J Sports Med. 41(7):1565-70, 2013
                                        12. Choi CJ et al: Characteristics of radial tears in the posterior horn of the medial meniscus compared to horizontal tears. Clin Orthop Surg. 3(2):128-32, 2011
                                        13. Elvey MH et al: Horizontal cleavage tear of discoid medial meniscus diagnosed on MRI and treated with arthroscopic partial resection. Knee Surg Sports Traumatol Arthrosc. 19(11):1860-7, 2011
                                        14. Hoffelner T et al: Arthroscopic all-inside meniscal repair--Does the meniscus heal? A clinical and radiological follow-up examination to verify meniscal healing using a 3-T MRI. Skeletal Radiol. 40(2):181-7, 2011
                                        15. McKnight A et al: Meniscal tears with displaced fragments: common patterns on magnetic resonance imaging. Skeletal Radiol. 39(3):279-83, 2010
                                        16. Englund M et al: The role of the meniscus in knee osteoarthritis: a cause or consequence? Radiol Clin North Am. 47(4):703-12, 2009
                                        17. Galea A et al: The accuracy of magnetic resonance imaging scanning and its influence on management decisions in knee surgery. Arthroscopy. 25(5):473-80, 2009
                                        18. Grossman JW et al: Comparison of the accuracy rates of 3-T and 1.5-T MRI of the knee in the diagnosis of meniscal tear. AJR Am J Roentgenol. 193(2):509-14, 2009
                                        19. Kim JM et al: Inframeniscal portal for horizontal tears of the meniscus. Arthroscopy. 25(3):269-73, 2009
                                        20. Kuikka PI et al: Magnetic resonance imaging in acute traumatic and chronic meniscal tears of the knee: a diagnostic accuracy study in young adults. Am J Sports Med. 37(5):1003-8, 2009
                                        21. Wolff AB et al: Comparison of spin echo T1-weighted sequences versus fast spin-echo proton density-weighted sequences for evaluation of meniscal tears at 1.5 T. Skeletal Radiol. 38(1):21-9, 2009
                                        22. De Smet AA et al: Clinical and MRI findings associated with false-positive knee MR diagnoses of medial meniscal tears. AJR Am J Roentgenol. 191(1):93-9, 2008
                                        23. Englund M et al: Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med. 359(11):1108-15, 2008
                                        24. Magee T: MR findings of meniscal extrusion correlated with arthroscopy. J Magn Reson Imaging. 28(2):466-70, 2008
                                        25. Mustonen AO et al: MRI of acute meniscal injury associated with tibial plateau fractures: prevalence, type, and location. AJR Am J Roentgenol. 191(4):1002-9, 2008
                                        26. Pujol N et al: Meniscal healing after meniscal repair: a CT arthrography assessment. Am J Sports Med. 36(8):1489-95, 2008
                                        27. Sohn DH et al: Meniscal debridement: current concepts. J Knee Surg. 21(2):145-53, 2008
                                        28. Turman KA et al: Meniscal repair: indications and techniques. J Knee Surg. 21(2):154-62, 2008
                                        29. Costa CR et al: Medial meniscus extrusion on knee MRI: is extent associated with severity of degeneration or type of tear? AJR Am J Roentgenol. 183(1):17-23, 2004
                                        30. Kidron A et al: Radial tears associated with cleavage tears of the medial meniscus in athletes. Arthroscopy. 18(3):254-6, 2002
                                        31. Ferrer-Roca O et al: Lesions of the meniscus. Part II: Horizontal cleavages and lateral cysts. Clin Orthop Relat Res. (146):301-7, 1980
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Top Differential Diagnoses

                                              • Pathology

                                                • Clinical Issues

                                                  • Diagnostic Checklist

                                                    TERMINOLOGY

                                                    • Abbreviations

                                                      • Horizontal tear (HT)

                                                    • Synonyms

                                                      • Meniscus fraying (= minimal HT)

                                                    • Definitions

                                                      • Meniscus tear occurring in axial (horizontal) plane, transecting through long axis of meniscus
                                                      • HT is preferred term according to ISAKOS classification system
                                                      • Meniscus red zone: outer 1/3 of meniscus = vascular portion of meniscus
                                                      • Meniscus red-white junction: middle 1/3 of meniscus between peripheral zone and free edge
                                                      • Meniscus white zone: inner 1/3 of meniscus near free edge, nonvascular

                                                    IMAGING

                                                    • General Features

                                                      • CT Findings

                                                        • MR Findings

                                                          • Imaging Recommendations

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                CLINICAL ISSUES

                                                                • Presentation

                                                                  • Demographics

                                                                    • Natural History & Prognosis

                                                                      • Treatment

                                                                        DIAGNOSTIC CHECKLIST

                                                                        • Consider

                                                                          • Image Interpretation Pearls

                                                                            • Reporting Tips

                                                                              Selected References

                                                                              1. Hoover KB et al: Reliability of meniscus tear description: a study using MRI from the Osteoarthritis Initiative. Rheumatol Int. 40(4):635-41, 2020
                                                                              2. Matar HE et al: Degenerative meniscal tears of the knee: evaluation and management. Br J Hosp Med (Lond). 80(1):46-50, 2019
                                                                              3. Amano H et al: Analysis of displacement and deformation of the medial meniscus with a horizontal tear using a three-dimensional computer model. Knee Surg Sports Traumatol Arthrosc. 23(4):1153-60, 2015
                                                                              4. Arno S et al: Tibiofemoral contact mechanics following a horizontal cleavage lesion in the posterior horn of the medial meniscus. J Orthop Res. 33(4):584-90, 2015
                                                                              5. Kurzweil PR et al: Repair of horizontal meniscus tears: a systematic review. Arthroscopy. 30(11):1513-9, 2014
                                                                              6. Nguyen JC et al: MR imaging-based diagnosis and classification of meniscal tears. Radiographics. 34(4):981-99, 2014
                                                                              7. Davis KW et al: Magnetic resonance imaging and arthroscopic appearance of the menisci of the knee. Clin Sports Med. 32(3):449-75, 2013
                                                                              8. Kim JR et al: Traumatic and non-traumatic isolated horizontal meniscal tears of the knee in patients less than 40 years of age. Eur J Orthop Surg Traumatol. 23(5):589-93, 2013
                                                                              9. Pujol N et al: Magnetic resonance imaging is not suitable for interpretation of meniscal status ten years after arthroscopic repair. Int Orthop. 37(12):2371-6, 2013
                                                                              10. Shieh A et al: Meniscus tear patterns in relation to skeletal immaturity: children versus adolescents. Am J Sports Med. 41(12):2779-83, 2013
                                                                              11. Yim JH et al: A comparative study of meniscectomy and nonoperative treatment for degenerative horizontal tears of the medial meniscus. Am J Sports Med. 41(7):1565-70, 2013
                                                                              12. Choi CJ et al: Characteristics of radial tears in the posterior horn of the medial meniscus compared to horizontal tears. Clin Orthop Surg. 3(2):128-32, 2011
                                                                              13. Elvey MH et al: Horizontal cleavage tear of discoid medial meniscus diagnosed on MRI and treated with arthroscopic partial resection. Knee Surg Sports Traumatol Arthrosc. 19(11):1860-7, 2011
                                                                              14. Hoffelner T et al: Arthroscopic all-inside meniscal repair--Does the meniscus heal? A clinical and radiological follow-up examination to verify meniscal healing using a 3-T MRI. Skeletal Radiol. 40(2):181-7, 2011
                                                                              15. McKnight A et al: Meniscal tears with displaced fragments: common patterns on magnetic resonance imaging. Skeletal Radiol. 39(3):279-83, 2010
                                                                              16. Englund M et al: The role of the meniscus in knee osteoarthritis: a cause or consequence? Radiol Clin North Am. 47(4):703-12, 2009
                                                                              17. Galea A et al: The accuracy of magnetic resonance imaging scanning and its influence on management decisions in knee surgery. Arthroscopy. 25(5):473-80, 2009
                                                                              18. Grossman JW et al: Comparison of the accuracy rates of 3-T and 1.5-T MRI of the knee in the diagnosis of meniscal tear. AJR Am J Roentgenol. 193(2):509-14, 2009
                                                                              19. Kim JM et al: Inframeniscal portal for horizontal tears of the meniscus. Arthroscopy. 25(3):269-73, 2009
                                                                              20. Kuikka PI et al: Magnetic resonance imaging in acute traumatic and chronic meniscal tears of the knee: a diagnostic accuracy study in young adults. Am J Sports Med. 37(5):1003-8, 2009
                                                                              21. Wolff AB et al: Comparison of spin echo T1-weighted sequences versus fast spin-echo proton density-weighted sequences for evaluation of meniscal tears at 1.5 T. Skeletal Radiol. 38(1):21-9, 2009
                                                                              22. De Smet AA et al: Clinical and MRI findings associated with false-positive knee MR diagnoses of medial meniscal tears. AJR Am J Roentgenol. 191(1):93-9, 2008
                                                                              23. Englund M et al: Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med. 359(11):1108-15, 2008
                                                                              24. Magee T: MR findings of meniscal extrusion correlated with arthroscopy. J Magn Reson Imaging. 28(2):466-70, 2008
                                                                              25. Mustonen AO et al: MRI of acute meniscal injury associated with tibial plateau fractures: prevalence, type, and location. AJR Am J Roentgenol. 191(4):1002-9, 2008
                                                                              26. Pujol N et al: Meniscal healing after meniscal repair: a CT arthrography assessment. Am J Sports Med. 36(8):1489-95, 2008
                                                                              27. Sohn DH et al: Meniscal debridement: current concepts. J Knee Surg. 21(2):145-53, 2008
                                                                              28. Turman KA et al: Meniscal repair: indications and techniques. J Knee Surg. 21(2):154-62, 2008
                                                                              29. Costa CR et al: Medial meniscus extrusion on knee MRI: is extent associated with severity of degeneration or type of tear? AJR Am J Roentgenol. 183(1):17-23, 2004
                                                                              30. Kidron A et al: Radial tears associated with cleavage tears of the medial meniscus in athletes. Arthroscopy. 18(3):254-6, 2002
                                                                              31. Ferrer-Roca O et al: Lesions of the meniscus. Part II: Horizontal cleavages and lateral cysts. Clin Orthop Relat Res. (146):301-7, 1980