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Updated: Oct 4 2021

Meniscus Tear

  • Snapshot
    • A 25-year-old woman twisted and injured her right knee during a soccer game 4 weeks ago. At that time, there was moderate knee swelling which has since resolved. She reports intermittent medial right knee pain and a sensation of the joint giving way since then. Her symptoms are aggravated by twisting or squatting. On physical exam, there is a mild effusion, medial joint line tenderness, and a positive medial McMurray test. Valgus stress reveals no pain or joint opening. Anterior and posterior drawer test is negative.
  • Introduction
    • Clinical definition
      • a knee injury caused by meniscal tears, categorized into two types
        • acute meniscus tear
        • age-related degeneration of meniscus
      • part of the "terrible triad"
        • anterior cruciate ligament tear
        • medial collateral ligament tear
        • meniscus tear
    • Associated conditions
      • > 30% associated with anterior cruciate ligament injury
  • Epidemiology
    • Demographics
      • male > female
      • < 40 years of age are more likely to have acute tears
      • > 40 years of age are more likely to have degenerative tears
      • medial meniscus tears are more common than lateral meniscus tears
        • due to decreased mobility of the medial meniscus as it attaches to the MCL
    • Location
      • menisci are located between the femoral condyles and tibial plateau
    • Risk factors
      • acute tears
        • sports
      • degenerative tears
        • older age
        • male gender
        • work-related use of knee (kneeling, squatting, and stair climbing)
      • obesity
    • Pathogenesis
      • two most common mechanisms
        • non-contact trauma from twisting of the knee or sudden acceleration and directional change, often in the context of sports
        • contact injury with varus or valgus forces on the knee
        • repetitive normal forces from age-related degeneration
          • menisci are less compliant with increasing age
  • Presentation
    • Symptoms
      • persistent joint pain after inciting event (acute tears)
      • insidious onset of knee pain (degenerative tears)
      • locking, popping, or catching of the knee during ambulation
        • pain during ambulation, especially with climbing stairs
      • sensation of joint giving way
    • Physical exam
      • knee effusion and swelling that worsens with activity
        • more common with acute injuries
      • knee pain that worsens with motion, especially with deep knee flexion
      • impaired range of motion
      • focal joint tenderness
      • normal patellar tracking
      • positive Thessaly test
        • standing with the knee flexed to 20 degrees, have the patient twist to externally and internally rotate the leg
        • discomfort or mechanical symptoms is a positive test
      • positive McMurray test
        • for medial meniscus tear
          • flex the knee and palpate medial side of the knee
          • externally rotate the leg and bring the knee into extension
          • palpable pop or click is a positive test
        • for lateral meniscus tear
          • flex the knee and palpate lateral side of the knee
          • internally rotate the leg and bring the knee into extension
          • palpable pop or click is a positive test
  • Imaging
    • Radiograph
      • indications
        • to rule out other bony pathologies
      • findings
        • typically normal
        • may show secondary findings such as joint effusion
    • Magnetic resonance imaging
      • indications
        • to confirm a meniscus tear when the diagnosis is unclear
      • findings
        • hyperintense signal inside the meniscus
  • Studies
    • Making the diagnosis
      • most cases are clinically diagnosed
  • Differential
    • Anterior or posterior cruciate ligament injury
      • distinguishing factor
        • positive drawer sign
    • Osteoarthritis of the knee
      • distinguishing factor
        • no diffusion present
        • joint stiffness is typically present
  • Treatment
    • Management approach
      • meniscal tears can be managed conservatively or with surgery and depends on various patient factors, including the patient’s age, the presence of comorbidities, and extent of the tear
    • Conservative
      • conservative treatment
        • indications
          • degenerative tears
          • asymptomatic tears
          • patients with multiple comorbidities and poor surgical candidates
        • modalities
          • rest and ice
          • use of crutches
          • knee sleeves
          • physical therapy
    • Medical
      • nonsteroidal anti-inflammatory drugs
        • indications
          • pain management
    • Operative
      • arthroscopic repair
        • indications
          • symptomatic tears
          • failure of conservative management
        • surgeries
          • partial meniscectomy
          • meniscal repair
  • Complications
    • Fibrosis
    • Septic arthritis
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