Meniscal tear

• Meniscal tear:

  • When knee injury causes damage/tears the meniscus
  • Often occurs during twisting movements in the knee
  • In young patients often happens when playing sports
  • In older people the meniscus is more prone to injury and tears can occur with minor twisting movements
  • The initial injury can be accompanied by a pop sound or sensation
• Symptoms:

  • Pain
  • Swelling/effusion
  • Stiffness
  • Restricted range of motion
  • Locking of the knee, catching or clicking
  • Instability of the knee - giving way
  • Pain may be referred to hip or lower back
• Examination findings:

  • Localised tenderness on the joint line - lateral joint line in lateral meniscal tear, and medial joint line in medial meniscal tears
  • Swelling/effusion
  • Restricted range of motion
  • Special tests - McMurray's and Apley grind tests - not generally used in clinical practice as can cause pain and worsen meniscal injury
• McMurry's test for lateral meniscal damage:

  • Patient lies supine, examiner flexes the knee
  • Examiner internally rotates the foot and adducts the thigh
  • Examiner applies varus stress to the knee (push inside of knee outward)
  • Examiner carefully extends the knee
  • All of this puts pressure on the lateral compartment of the knee and if there is pain or restriction this indicates lateral meniscal damage
• McMurray's test for medial meniscal damage:

  • Patient lies supine, examiner flexes the knee
  • Examiner externally rotates the foot and abducts the thigh
  • Examiner applies valgus stress to the knee (push outside of knee inward)
  • Examiner carefully extends the knee
  • All of this puts pressure on the medial compartment of the knee and if there is pain or restriction this indicates medial meniscal damage
• When and how to refer:

  • Suspect fracture if meets Ottawa knee rules, would need to go to A+E for X-ray
  • Suspect significant soft tissue injury if meets criteria - acute knee pain following injury with pop or snap sensation, locking etc
  • Suspect that the soft tissue injury is a meniscal tear based on history and examination findings
  • Would need review in line with local pathways e.g. A+E, fracture clinic, acute knee clinic
• Investigations:

  • Imaging - first line is MRI
  • Special - arthroscopy - can be used to visualise meniscus within the joint and diagnose a meniscal tear - can also be used to repair or remove damaged sections of meniscus
• Conservative management:

  • Rest, ice, compression, elevation
  • Analgesia - NSAIDs
  • Physiotherapy
• Surgical arthroscopy options:

  • Repair meniscus if possible
  • Resection of affected portion of meniscus - often results in osteoarthritis