OBJECTIVE The purpose of this study was to determine the positive predictive value (PPV) for diagnosis of discoid lateral meniscal tear using MR imaging and to describe various patterns of such tears in the knee. METHODS MR reports of 77 patients (10-67 years old) who underwent prospective MR imaging that led to a diagnosis of discoid lateral meniscal tear were correlated with arthroscopic results. MR images obtained in 71 patients confirmed to have discoid lateral meniscial tear were retrospectively reviewed for the presence, site, and pattern of discoid lateral meniscal tear, including type of displacement of the torn segment. MR abnormalities were correlated with arthroscopic findings. RESULTS For the prospective MR interpretations, the PPV for discoid meniscus was 92%. PPV for discoid meniscal tear was 57%. PPVs for individual types of discoid meniscal tears were 46% (peripheral tear, 19/41), 76% (peripheral tear with horizontal tears, 16/21), 56% (horizontal tear, 5/9), 50% (transverse tear, 1/2), 67% (horizontal tear combined with transverse tear, 2/3), and 100% (longitudinal tear, 1/1). Peripheral tear alone and peripheral tear with horizontal tear were the most common types of tears (n = 20, 28%). Multiple tears (n = 34, 48%) were common. Displacement of the torn segments was seen in 51 patients (72%). CONCLUSIONS MR imaging has a low PPV for diagnosing discoid lateral meniscal tear. Peripheral tear alone and peripheral tear with horizontal tear were the most common types of tears, and displacement of the torn segment was frequent.