In this paper, we provide a complete description of the minimal primes of ideals generated by adjacent $2$-minors, in terms of the so-called admissible sets and associated lattice ideals. We prove that for these ideals, the properties of being unmixed, Cohen-Macaulay, level, Gorenstein, and complete intersection are equivalent. Moreover, we give a combinatorial characterization of all convex collections of cells satisfying any of these equivalent properties. Finally, we study the radicality of these ideals and derive necessary combinatorial conditions based on minimal non-radical configurations.