Updated: 1/31/2019

Meniscus Tear

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Snapshot
  • A 65-year-old woman presents with intermittent knee pain and locking for the past few months. Her symptoms are worse when climbing stairs or when squatting. She denies any inciting trauma or event and denies participation in any rigorous sports. She has no other significant past medical history. On physical exam, there is a mild effusion with a positive McMurray test. Posterior and anterior drawer tests are 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
      • medial meniscus tear
  • 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
      • lateral meniscus tears are most common
    • 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
  • Associated conditions
    • >30% associated with anterior cruciate ligament injury
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
    • a 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
    • an impaired range of motion
    • focal joint tenderness
    • normal patellar tracking
    • 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
    • indication
      • 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 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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