Glossary
Horizontal (degenerative) meniscus tear
Quick answer
A horizontal meniscus tear splits the meniscus into upper and lower layers, like a pitta bread opened along its edge. It usually develops gradually with age rather than from one injury, and most respond to physiotherapy, explains Doha knee surgeon Dr. Pablo Gelber, who treats them at Aman Hospital.
What the report means
Radiologists also call this a horizontal cleavage tear or degenerative tear. The split runs parallel to the top of the shin bone, usually in the posterior horn of the medial meniscus. Sometimes fluid escapes through it and forms a small parameniscal cyst at the side of the knee.
This tear is part of the normal ageing of the meniscus and is very common on MRI after the age of forty, including in people with no symptoms.
Does it matter?
Often less than people fear. A degenerative tear is frequently a sign of early wear in the joint rather than the main cause of pain. Large studies have shown that many people with this type of tear do as well with structured exercise as with keyhole surgery.
It matters more if a flap breaks off and catches, causing the knee to lock, or if pain persists despite a good rehabilitation programme.
How it is treated
First-line treatment is usually physiotherapy to strengthen the thigh and hip, weight management where relevant, and short-term pain relief. Injections are sometimes used. Arthroscopy is reserved for true mechanical symptoms or failure of a fair trial of non-surgical care, and an X-ray standing up is often taken to check for arthritis.
Frequently asked questions
Is a degenerative meniscus tear caused by something I did?
Usually not. It reflects gradual weakening of the meniscus with age and load. A minor movement such as squatting or kneeling can make an existing degenerative tear noticeable.
Should a horizontal tear be operated on?
Most do not need surgery. Keyhole trimming is considered when there is locking or a catching flap, or when well-run physiotherapy has not helped.
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