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Knee Bone or Joint Injury

Bucket Handle Meniscus Tear and Other Common Meniscus Tears

Minute Read


Posted 1 year ago


Last updated: 29/11/2022


by James McCormack

The meniscus of the knee is a cartilage structure that sits between the bones of the knee, the tibia and the femur. It comprises of two semi-circular or C-shaped arches on the inside and outside of the knee. The blood supply to the meniscus is relatively poor compared to other tissues of the body, but there is some blood supply to the outer rim of the meniscus. The blood supply becomes increasingly reduced the further toward the middle of the knee. Hence, the outer rim is called the red area, the inner rim is the white area, and the middle is the red-white area.

A tear of the meniscus is a very common injury to the knee. Tears can be caused by a chronic overload of the meniscus or an acute injury, usually a twist or rotation of the knee or bending of the knee under heavy weight. There are different types of tears, each characterised by their location, direction and appearance. Below are a few of the most common.

Photo of knee injury treated with ice

Management of Meniscus Tears

Knee pain is the most common symptom of a meniscus injury; this can often be felt along the joint line, either on the inside, back, or outside of the knee. In addition, many people will have swelling, this is often diffuse and surrounds the knee, so there is a loss of definition of the bony anatomical points of the knee. In most of these cases, these symptoms will reduce with adequate rest and appropriate physical therapy, and no further treatment is needed. Physical therapy will address muscle weakness, excessive tightness and support changes to lifestyle factors, such as being overweight, not active enough or doing too much activity.

Less commonly, symptoms of instability, giving way, or locking of the joint may occur. These are symptoms to be referred to an orthopaedic knee consultant or sports doctor for imaging. Surgery will be required in many of these cases—either partial or total meniscectomy or a meniscus repair, followed by physical therapy.


Bucket Handle Meniscus Tear

A bucket handle tear is a break through the middle of the meniscus body. The tear follows the meniscus curve and leaves the meniscus attachments intact at the anterior and posterior horns. It creates a free-to-move segment of the meniscus that looks like a handle on a bucket. These types of tears account for 10% of all meniscus tears.

Occasionally this can be managed conservatively, and symptoms might settle. But more frequently, surgery will be suggested. Depending on the location and blood supply to the tear, these can either be repaired, or the loose, unstable segment can be removed. If there is significant osteoarthritis, the surgery will be much less likely to reduce symptoms, so it may not be proposed as an appropriate treatment.

Parrot Beak Meniscal Tear

A parrot beak meniscal tear is a form of radial tear which runs obliquely and has a curved V shape, like a parrot’s beak. Due to the loose flap of the meniscus, this is generally an unstable tear and will be symptomatic.

This tear does not usually heal as it is located in the inner part of the meniscus, where there is poor blood supply. It may become thinner and more stable so that it no longer catches, thus reducing symptoms. If symptoms do not subside with conservative management, partial meniscectomy surgery will be conducted to remove the unstable cartilage. A repair is not effective with the limited blood supply to this area.

Degenerative Meniscus Tear

A degenerative meniscus tear is not caused by any specific trauma. It can develop gradually and worsen, pain may be less clear. There is a high prevalence of degenerative tears over 50 years old, about 35%, which is evenly divided between those who experience symptoms or no symptoms. This is more common in middle-aged and older individuals. Contributing factors can be excess weight, poor fitness and activity levels, weakness or excessive tightness in quadriceps and glute muscles or overuse. There is a close connection between degenerative tears and osteoarthritis.

Treating these tears is rarely surgical, and with conservative management, most people will feel improvements within 3-6 months. Treatment will need to include addressing lifestyle factors, such as weight loss if these are relevant.

Horizontal Meniscus Tear

Horizontal meniscus tears are also known as cleavage or split tears. These run parallel to the tibial plateau and can be hard to see in surgery. These tend to be another form of degenerative tear and are more common in older people. The tears can run from the inner white portion of the meniscus through to the mid or outer parts and, on some occasions, all the way through. A horizontal meniscus tear is more common in a discoid meniscus, which is a congenitally, abnormally shaped meniscus. The tears can completely rupture the meniscus, and the free part can migrate, twist or flip, causing worse symptoms.

Most horizontal tears are managed conservatively unless is it thought that surgery to remove part of the meniscus to make it more stable. This can be done depending on which zone the tear is in, in terms of blood supply.

Radial Meniscus Tear

A radial tear of the meniscus is from the inner border into the middle of the body of the meniscus. This is a very common type of meniscus tear and is seen in both young and older adults.

Due to this location in the area of the meniscus with minimal blood supply, this type of tear is unlikely to heal therefore it will be initially managed conservatively and if symptoms do not settle, surgery will be offered. Surgery in this location will be to remove the damaged portion of the meniscus rather than a repair due to the poor blood supply.

Intrasubstance meniscus tear

Intrasubstance meniscus tears are also sometimes called incomplete tears. These can be common in younger adults in their 20s and 30s. These are a sign of early degenerative changes of the meniscus.

In the vast majority of cases these are stable and respond well to conservative management and will not require surgery.

Physiotherapy with James McCormack

This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments for £45.

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