 Now, we said earlier that this vertical longitudinal tear is one type of up-and-down tear. There's another kind of up-and-down tear that we should talk about, and that is one that starts in the inner third. And instead of going up and down, that's parallel to the capsule. In other words, that's parallel to the capsule, which we'll imagine is here in red that has some blood in it. It is perpendicular to the capsule, kind of like the spokes on a wheel, right? The spokes on the wheel are perpendicular to the outer part of this circle. Kind of like the wheels on the bus, go round and round, right? So what does that look like? Well, here's the spoke on the wheel, right here. It's coming right at you. It's coming at you. Because it makes a little V, that's a radial tear. And that goes into the screen. That also goes up and down. It's just in a different axis. Now we're interested in this tear because this tear can get a little bit nasty. Well, how come? Because it's in an area that doesn't heal. Remember, we have outer third, red-red zone, middle third, red-white zone, inner third, white-white zone. The white-white zone has no vascularity. It doesn't heal. Okay, so we have a little tear there. When do we mess with it? When it's symptomatic. But what kind of symptoms? Pain? Maybe not. Because pain alone, maybe it breaks off, maybe it scars, maybe the pain goes away. But if it's pain and clicking or pain and locking or pain and progressive arthritis, then it has to be addressed. Now in the orthopedic literature they say that if the tear has a depth of greater than six to eight millimeters, that those are more likely to become unstable, to propagate, and even to lead to consequences like fragmentation, locking, and conglomeration. But I think we've gotten a little more liberal as time has gone on and less aggressive in trying to resect these tears because there's no sewing them. You just go in with a claw and you just claw a matter there, which is kind of ugly. So what do we mean by depth? Depth is the measurement from here, the inner edge, to the outer edge. So depth goes this way. Remember, length is completely different for the longitudinal vertical tear. For the radial vertical tear, we're more interested in this character. Now we also have gapping, you know, the side to side dimension. So the tears can get a little wide and the more gap they are, the more troublesome they are. So depth is important, the measurement from here to here, greater than six to eight millimeters, but also the side to side dimension because gapping can lead to instability. Instability of what? Instability of the miscous. So where might we see a problematic area of gapping back here near the meniscus root? Remember we have a posterior horn, posterior third, a body, middle third, an anterior horn, anterior third to keep it simple. We also have in the deepest attachment of the meniscus, the meniscus root in the back and in the front. And although we haven't drawn them in, there are ligaments. So confuse the meniscus root, which is meniscus, with the meniscus root ligament. You can tear the meniscus from its root, you can tear the ligament from the bone. Now they both have the same consequence. But what happens if you have one of these radial tears and it keeps going back, back, back, back, back to quote Chris Berman and it keeps going back, back, back, back and boom it goes to the outer surface. Now we've got a problem, right? The meniscus isn't anchored to itself anymore. Doesn't matter where the ligament's still there, this is not attached to that. And so they spread apart and the meniscus starts to float this way, out of the edge of the femur and the tibia. And now you essentially have a meniscus that extrudes itself. So these very large radial root tears are problematic. The little ones, we leave all of those alone. We hardly ever touch the root radial tears that don't go all the way through. Even the ones that almost go all the way through we don't touch. But the ones that clearly go all the way from the inner third to the outer third, the meniscus is starting to gap and separate those we've got to go after. So we've learned about two very important vertically oriented tears today. The one that's longitudinal and parallel to the outer portion of the meniscus. And the one that's perpendicular to the outer arc of the meniscus. The one that's parallel is less problematic because it's in the red-red zone. The one that is perpendicular is problematic. Now if this radial tear were to arc, if it were to do something like, say, this, we would call it a flap tear. So radial tears are straighter. If it were to arc and it would get a little bit wider and a little bit longer, now we're into a parrot beat tear, which happens to like the body horn junctions. Let's draw another meniscus for a moment just so we can demonstrate one other thing for completeness. I realize my meniscus is a little bit thin here. But I think you can see it. Actually, I'm going to make it thicker because I know I'm going to get reprimanded if I don't. Let's make a thicker meniscus. Let me erase this one. Give you a little more, a little more visual stimulation here. Oh, wow, that's a really thick one. Yeah, this is for all of us out there that are over age 60. So here's a big fat meniscus. Okay, now let's make it thinner. Let's make our line thinner. And let's change the color. And now let's assume we have a longitudinal tear and it's in the middle third. It would be a vertical longitudinal tear in the middle third. And if that vertical longitudinal tear starts to gap and get wider and wider and wider and wider and all of a sudden this portion of the meniscus starts to go inwards, now we have ourselves a bucket handle tear. So a bucket handle tear really starts out as a vertical tear usually in the center of the meniscus. And that will be a story for another day.