Meniscal Tears

• Types of knee ligaments

  • Anterior cruciate ligament
  • Posterior cruciate ligament
  • Lateral collateral ligament
  • Medial collateral ligament
• Meniscal tears are a common form of knee injury involving damage to the meniscus, which is cartilage in the knee joint
• Knee

  A hinge joint
• Components of the knee

  • Menisci
  • Medial meniscus
  • Lateral meniscus
  • Condyles
  • Patellofemoral joint
  • Trochlea
  • Quadriceps tendon
  • Patella
  • Patellar ligament
• Function of menisci in the knee

  Help the femur and tibia fit together and move smoothly across each other, act as a shock absorber, distribute weight throughout the joint, and help stabilise the joint
• Meniscal tears often occur during twisting movements in the knee, especially in young patients playing sports
• With increasing age, the meniscus becomes more prone to injury, tears can occur with minor twisting movements in older patients
• Initial injury of meniscal tears can be accompanied by a “pop” sound or sensation
• Symptoms of meniscal tears

  • Pain
  • Swelling
  • Stiffness
  • Restricted range of motion
  • Locking of the knee
  • Instability or the knee “giving way”
  • Pain may be referred to the hip or lower back
• Examination findings of meniscal tears

  • Localised tenderness on the joint line
  • Swelling
  • Restricted range of motion
• Special tests for meniscal tears

  • McMurray’s test
  • Apley grind test
• McMurray’s test involves the patient lying supine
• McMurray’s Test

  Patient lies supine, examiner flexes the knee, internally rotates the tibia, applies varus pressure, extends the knee. Pain or restriction indicates lateral meniscal damage. Repeating with external rotation and valgus pressure tests for medial meniscal damage
• Apley Grind Test


  Patient lies prone, flexes knee to 90 degrees, downward pressure applied through the leg into the knee, tibia internally and externally rotated. Pain indicates meniscal damage, localized to the area of damage (e.g., medial or lateral meniscus)
• Ottawa Knee Rules

  • Age 55 or above
  • Patella tenderness (with no tenderness elsewhere)
  • Fibular head tenderness
  • Cannot flex the knee to 90 degrees
  • Cannot weight bear (cannot take 4 steps – limping steps still count)
• Bone fractures are worth considering as a differential diagnosis in patients presenting with acute knee injuries
• The Ottawa knee rules can be used to determine whether a patient requires an x-ray of the knee after an acute knee injury to look for a fracture
• MRI scan is usually the first-line imaging investigation for establishing the diagnosis
• Arthroscopy can be used to visualise the meniscus within the joint and is the gold-standard investigation for diagnosing a meniscal tear. It can also be used to repair or remove damaged sections of the meniscus
• The NICE clinical knowledge summaries on knee pain recommend urgent referral in patients with an acute onset of knee pain associated with symptoms suggestive of an acute meniscal tear
• Key symptoms of meniscal tears include: a “pop”, rapid onset swelling, instability or giving way, locking
• Conservative management of most acute soft tissue injuries, including meniscal tears, is with the RICE mnemonic: Rest, Ice, Compression, Elevation
• NSAIDs are usually used first-line for analgesia in MSK injuries
• Physiotherapy can be used for rehabilitation after the initial pain and swelling have settled
• Surgery may be required involving arthroscopy (keyhole surgery) of the knee joint. The main options are repair of the meniscus if possible or resection of the affected portion of the meniscus (this often results in osteoarthritis)