Knee

Meniscus Injury

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Meniscus Injury, Meniscus Tear, Meniscal Injury, Lateral Meniscal Tear, Medial Meniscal Tear, Lateral Meniscus Tear, Medial Meniscus Tear

  • Epidemiology
  1. Most common Knee Injury
  • Anatomy
  • Menisci
  1. Fibrocartilaginous C-shaped (semilunar) objects
    1. Medial meniscus (90%)
      1. Less mobile than lateral meniscus
    2. Lateral meniscus (10%)
  2. Cushion forces between femur and tibia
  • Mechanism
  • Twisting injury
  1. Fixed tibial rotation with knee flexion or extension
  • Associated injuries
  • Symptoms
  1. Twisting injury to knee while weight bearing
  2. Initial tearing, painful sensation felt
  3. Pain localized to affected meniscus
  4. Intermittent locking or buckling sensation
  5. Gradual onset of effusion following injury
  6. Provocative
    1. Stair climbing or stair descent
    2. Squatting
  • Signs
  1. Joint effusion
  2. McMurray's Test positive
  3. Apley's Compression Test positive
  4. Apley's Distraction Test negative
  5. Knee Bounce Test positive
  • Radiology
  • Management
  • Conservative
  1. RICE-M
  2. NSAIDs
  3. Crutch walking
  4. Physical therapy
    1. Gentle knee range of motion Exercises after 2-3 days
      1. Consider Swimming
    2. Quadriceps strengthening Exercises for 2-4 weeks
      1. Initially perform with knee extended
    3. Active rehabilitation is as effective as arthroscopy for pain and function in degenerative tears
      1. Herrlin (2007) Knee Surg Sports Traumatol Arthrosc 15(4): 393-401 +PMID:17216272 [PubMed]
  • Management
  • Arthroscopy
  1. Indications
    1. Irreducible locking
    2. Mechanical symptoms (locking or catching)
    3. Refractory meniscus symptoms (e.g. pain) despite above management
  2. Efficacy arthroscopy, meniscectomy and debridement
    1. No longterm benefit in middle aged and older patients (with or without Knee DJD)
    2. No significant improvement in knee catching or locking in those with meniscal tear
    3. Exercise therapy is preferred
    4. Sihvonen (2016) Ann Intern Med 164(7): 449-55 [PubMed]
    5. Thorlund (2015) BMJ 350:h2747 [PubMed]
    6. Khan (2014) CMAJ 186(14):1057-64 [PubMed]
  • Complications
  • References
  1. Mercier (1995) Practical Orthopedics, Mosby, p. 217-9
  2. Smith (1995) Am Fam Physician 51(4): 799-806 [PubMed]