II. Epidemiology

  1. Most common Knee Injury

III. Anatomy: Menisci

  1. Meniscus cushions forces between femur and tibia
  2. Fibrocartilaginous C-shaped (semilunar) objects
    1. Medial meniscus (90%)
      1. Less mobile than lateral meniscus
    2. Lateral meniscus (10%)

IV. Mechanism: Twisting injury

  1. Fixed tibial rotation with knee flexion or extension

V. Associated injuries

VI. Symptoms

  1. Twisting injury to knee while weight bearing
  2. Initial tearing, painful Sensation felt
  3. Pain localized to affected meniscus
  4. Buckling Sensation
  5. Gradual onset of effusion following injury
  6. Provocative
    1. Stair climbing or stair descent
    2. Squatting
  7. Knee Locking
    1. Intermittent Locking (common)
    2. Locked Knee Syndrome (uncommon)
      1. May result in persistent inability to flex and extend knee
      2. Meniscus Bucket Handle Tear refers to torn meniscus fragment that flips into intercondylar notch
        1. Prevents knee range of motion, and results in difficult ambulation
      3. May be associated with Anterior Cruciate Ligament Tear
      4. Indicates early MRI and orthopedic Consultation

VII. 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

VIII. Imaging

  1. Knee XRay
    1. Initial Knee Injury evaluation for Fracture
  2. Knee MRI
    1. Diagnosis of meniscal tear

IX. 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]

X. Management: Arthroscopy

  1. Indications
    1. Irreducible locking (see Locked Knee Syndrome above)
    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]

XI. Prognosis: Predictors of Best Longterm Outcomes

  1. Acute, non-degenerative meniscal tear
  2. Age <35 years old
  3. Vertical meniscal tear
  4. No cartilage injury
  5. Intact meniscal rim after meniscectomy

XII. Complications

XIII. References

  1. Mercier (1995) Practical Orthopedics, Mosby, p. 217-9
  2. Rashidzada (2020) Crit Dec Emerg Med 34(9): 16-7
  3. Smith (1995) Am Fam Physician 51(4): 799-806 [PubMed]

Images: Related links to external sites (from Bing)

Related Studies

Ontology: Tear of medial meniscus of knee (C0159971)

Concepts Injury or Poisoning (T037)
SnomedCT 302932006, 90832003
English Tear of med meniscus of knee, knee medial meniscus tears, torn medial meniscus, Tear of medial meniscus of knee joint, Tear of medial meniscus of knee, Torn medial meniscus, Tear of medial meniscus of knee (disorder)
Spanish laceración del menisco medial de la articulación de la rodilla, desgarramiento del menisco medial de la articulación de la rodilla, desgarro de menisco interno, desgarro de menisco medial de la rodilla (trastorno), desgarro de menisco medial de la rodilla, desgarro de menisco interno de la rodilla (trastorno), desgarro de menisco interno de la rodilla

Ontology: Tear of lateral meniscus of knee (C0159972)

Concepts Injury or Poisoning (T037)
SnomedCT 302933001, 34699001
Spanish desgarro de menisco externo, desgarramiento del menisco lateral de la articulación de la rodilla, laceración del menisco lateral de la articulación de la rodilla, desgarro de menisco lateral de la rodilla (trastorno), desgarro de menisco lateral de la rodilla, desgarro de menisco externo de la rodilla (trastorno), desgarro de menisco externo de la rodilla
English Tear of lat meniscus of knee, Lateral meniscal injury, Tear of lateral meniscus of knee joint, Torn lateral meniscus, Tear of lateral meniscus of knee, Tear of lateral meniscus of knee (disorder)

Ontology: Knee locking (C0231753)

Concepts Sign or Symptom (T184)
SnomedCT 1126007, 202113000, 202125002
English Locked knee, knee locking, knee lock, Locking (of);knee, knees lock, locking knee, lock knee, locked knee, knees locking, Locked knee (finding), Knee locking, Knee locking (finding), knee; locking, locking; knee, locking of knee
Dutch knie; op slot, op slot; knie
Spanish rodilla bloqueada (hallazgo), rodilla bloqueada

Ontology: Tear of meniscus of knee (C0238218)

Concepts Injury or Poisoning (T037)
ICD10 S83.20
SnomedCT 239720000, 156515005, 268057002
Dutch kraakbeenscheur in knie, meniscusruptuur, kniemeniscusscheur, meniscusscheur, meniscus; ruptuur, meniscus; scheur, ruptuur; meniscus, scheur; knie, kraakbeen, scheur; knie, meniscus, scheur; kraakbeen, knie, scheur; kraakbeen, scheur; meniscus
English Torn cartilage, Cartilage tear in knee, Catrilage tear in knee, Tear of meniscus of knee NOS, cartilage tear in knee, meniscal tear, Tear;meniscus;knee, meniscus rupture, torn cartilage, torn knee cartilage, meniscal tears, torn meniscus, Tear of meniscus of knee, Meniscus rupture, Meniscus tear of knee, Meniscus tear, Tear - meniscus, Cartilage tear - knee, Knee - internal derange, Torn meniscus, Tear of cartilage of knee, Tear of meniscus of knee (disorder), meniscus; rupture, meniscus; tear, rupture; meniscus, tear; cartilage, knee, tear; cartilage, tear; knee, cartilage, tear; knee, meniscus, tear; meniscus, meniscus knee tear
French Déchirure du cartilage du genou, Rupture du ménisque, Déchirure du ménisque
German Knorpelriss im Knie, Meniskusriss, Meniskusriss des Knies
Italian Leacerazione della cartilagine del ginocchio, Lacerazione cartilaginea del ginocchio, Rottura del menisco, Lacerazione del menisco del ginocchio
Portuguese Ruptura de cartilagem no joelho, Ruptura de cartilagem do joelho, Ruptura de menisco, Rasgadura de menisco, Rasgadura de menisco do joelho
Spanish Desgarro del cartílago de la rodilla, desgarro de cartílago de la rodilla, Rotura del menisco de la rodilla, Rotura de menisco, Rotura del menisco, desgarro de menisco de la rodilla (trastorno), desgarro de menisco de la rodilla, desgarro meniscal
Japanese 膝の軟骨断裂, ヒザノナンコツダンレツ, 半月板断裂, ハンゲツバンダンレツ, 膝の半月板断裂, ヒザノハンゲツバンダンレツ
Czech Přetržení chrupavky v koleni, Natržení chrupavky v koleni, Natržení menisku kolene, Ruptura menisku, Trhlina menisku
Hungarian Porcszakadás a térdben, Térdmeniscus szakadása, Meniscus szakadás, Meniscus szakadása

Ontology: Bucket handle tear (C0443166)

Concepts Injury or Poisoning (T037)
SnomedCT 263697003
Spanish desgarramiento en asa de balde (anomalía morfológica), desgarro en asa de balde (anomalía morfológica), desgarro en asa de balde, desgarramiento en asa de balde
English bucket handle tear, bucket handle tears, Bucket handle tear, Bucket handle tear (morphologic abnormality), bucket handle; tear, tear; bucket handle
Dutch bucket handle; scheur, scheur; bucket handle