Updated: 10/4/2021

Meniscus Tear

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  • 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
  • ETIOLOGY
    • 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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(M2.OR.17.4759) A 25-year-old male wrestler presents to his primary care physician for knee pain. He was in a wrestling match yesterday when he was abruptly taken down. Since then, he has had pain in his left knee. The patient states that at times it feels as if his knee locks as he moves it. The patient has a past medical history of anabolic steroid abuse; however, he claims to no longer be using them. His current medications include NSAIDs as needed for minor injuries from participating in sports. On physical exam, you note medial joint tenderness of the patient’s left knee, as well as some erythema and bruising. The patient has an antalgic gait as you observe him walking. Passive range of motion reveals a subtle clicking of the joint. There is absent anterior displacement of the tibia relative to the femur on an anterior drawer test. The rest of the physical exam, including examination of the contralateral knee is within normal limits. Which of the following structures is most likely damaged in this patient?

QID: 109014

Medial meniscus

82%

(50/61)

Lateral meniscus

3%

(2/61)

Medial collateral ligament

7%

(4/61)

Lateral collateral ligament

2%

(1/61)

Anterior cruciate ligament

5%

(3/61)

M 6 D

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