Horizontal cleavage tears may be unrelated to presenting knee symptoms
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Key takeaways:
- Horizontal cleavage tears can be asymptomatic and unrelated to knee symptoms.
- Degenerative tears are complex and linked with articular cartilage loss in older patients. Such cases may not be repairable.
KOLOA, Hawaii — Horizontal cleavage tears are common on MRI, often asymptomatic and the MRI appearance may not correlate with arthroscopy findings, according to a presenter here at Orthopedics Today Hawaii.
“The meniscus is still functional in many cases, and they may be totally unrelated to the patient's chief complaint or presenting knee symptoms. Address the actual pain source. Treat the patient and not the MRI,” Michael J. Stuart, MD, said.
Stuart said arthroscopy is necessary because an MRI captures a “moment in time.”
“When you get in there a month later [or] 6 months later than the MRI, there's going to be a tattered, torn, unstable, inferior leaflet that’s not repairable. It’s degenerative tissue. It’s a complex, multiplanar pattern. There’s an unstable leaflet with articular cartilage loss,” Stuart said.
Stuart said degenerative horizontal cleavage tears are complex and associated with articular cartilage loss in older patients. In such cases, tears may not be repairable. Risk factors for horizontal cleavage tear include malalignment, advanced age, obesity and preexisting arthritis, he said.
Stuart said orthopedic surgeons should individualize treatment according to a patient’s symptoms, chondral status, tear pattern, location, size and presence of associated meniscus cysts.
“I firmly believe in preserving meniscus function. Keep the circumferential fibers intact. Retain both leaflets, if possible. Always avoid total meniscectomy, regardless of patient age, and there [are] some cases where I've actually done a valgus-producing proximal tibial osteotomy in combination with a horizontal cleavage tear repair in young people,” Stuart said.
He said repair horizontal cleavage tears in younger patients who have associated meniscal cysts and minimal chondral damage. Surgeons may need to resect horizontal cleavage tears in patients with the degenerative, avascular, unstable meniscus tissue that cause pain and catch.
“The patient and surgeon are always prepared to resect, repair or do both,” he said.
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Stuart MJ. Horizontal cleavage tear in a 45-year-old: Just trim it. Presented at: Orthopedics Today Hawaii; Jan. 12-16, 2025; Koloa, Hawaii.
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