Meniscal Injury Workup
- Author: Sarjoo M Bhagia, MD; Chief Editor: Consuelo T Lorenzo, MD more...
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- If arthrocentesis is performed (see Procedures), send the fluid for analysis, though a hemarthrosis associated with acute injury often is evacuated only for patient comfort.
- Send nonbloody fluid to the laboratory for cell count and determination of glucose and protein levels, Gram stain, bacterial culture, and special tests (eg, crystals), as indicated.
- Posttraumatic aspiration of bloody fluid is suggestive of a cruciate ligament tear or an injury to the peripheral vascular part of the meniscus. If the bloody aspirate is associated with fat globules, it is highly suggestive of associated fractures.
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- Radiographic evaluation of the knee should include standing anteroposterior (AP), lateral, tunnel, and skyline views.
- MRI of the knee largely has replaced arthrography as the imaging modality of choice for the menisci, as the accuracy has been shown to be greater than 90%. MRI is not routinely required for the diagnosis of meniscal tears before proceeding with arthroscopic surgery; however, MRI helps confirm the diagnosis and provides additional information concerning the status of the ligaments and articular cartilage (see images below).
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- Arthrocentesis can be used as a diagnostic tool and a therapeutic procedure.
- Not all effusions require aspiration, though drainage of the bloody effusion provides symptomatic relief, improves examination accuracy, and helps confirm severity of the injury.
- Arthrocentesis can be accomplished quickly and easily with minimal patient discomfort. The knee is prepared in sterile fashion and anesthetized with local anesthetic to facilitate the use of a large-bore needle. The choice of the site of aspiration is a matter of operator preference. Accepted locations include the level of the joint line, which is 1 cm medial or lateral to the patellar tendon when the patient is seated. Alternatively, a location 2 cm medial or lateral to the anterior-superior patella when the patient is supine can be used. An 18-gauge needle is needed for aspiration of the viscous or bloody fluid.
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