Meniscal Injury Workup

  • Author: Sarjoo M Bhagia, MD; Chief Editor: Consuelo T Lorenzo, MD   more...
 
Updated: Jan 18, 2012
 

Laboratory Studies

  • 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.
Next

Imaging Studies

  • Radiographic evaluation of the knee should include standing anteroposterior (AP), lateral, tunnel, and skyline views.[13]
  • 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).[14] Magnetic resonance imaging scan showing a normal mMagnetic resonance imaging scan showing a normal meniscus. Magnetic resonance imaging scan showing a torn medMagnetic resonance imaging scan showing a torn medial meniscus.
Previous
Next

Procedures

  • Arthrocentesis
    • 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.
  • Arthroscopy of the knee is the criterion standard for the diagnosis of a meniscal tear. (See image below.)Arthroscopic probing of a posterior horn complex mArthroscopic probing of a posterior horn complex meniscal tear with multiple flaps.
Previous
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Sarjoo M Bhagia, MD  Consulting Staff, OrthoCarolina; Voluntary Teaching Faculty, Carolinas Rehabilitation

Sarjoo M Bhagia, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, North American Spine Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

Coauthor(s)

Michael Weinik, DO  Associate Chairman, Associate Professor, Physical Medicine and Rehabilitation, Temple University Hospital

Michael Weinik, DO is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Selina Yingqi Xing, MD, MS  Staff Physician, Department of Physical Medicine and Rehabilitation, Temple University

Selina Yingqi Xing, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Medical Association, and Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM  President and Director, Georgia Pain Physicians, PC; Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Emory University School of Medicine

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Medical Association, International Association for the Study of Pain, and Texas Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Michael T Andary, MD, MS  Professor, Residency Program Director, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine

Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists

Disclosure: Allergan Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

Kelly L Allen, MD  Medical Director, Medevals

Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD  Physiatrist, Department of Physical Medicine and Rehabilitation, Alegent Health Immanuel Rehabilitation Center

Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors wish to thank Kavita Gupta, DO, MEng, Department of Orthopedics, Center of Physical Medicine and Rehabilitation, University of Dentistry and Medicine of New Jersey, for his previous contributions to this article.

References

  1. Jackson JP. Degenerative changes in the knee after meniscectomy. Br Med J. Jun 1 1968;2(5604):525-7. [Medline]. [Full Text].

  2. Shrive NG, O'Connor JJ, Goodfellow JW. Load-bearing in the knee joint. Clin Orthop Relat Res. Mar-Apr 1978;279-87. [Medline].

  3. Renstrom P, Johnson RJ. Anatomy and biomechanics of the menisci. Clin Sports Med. Jul 1990;9(3):523-38. [Medline].

  4. Arnoczky SP, Warren RF. Microvasculature of the human meniscus. Am J Sports Med. Mar-Apr 1982;10(2):90-5. [Medline].

  5. Yeh PC, Starkey C, Lombardo S, Vitti G, Kharrazi FD. Epidemiology of Isolated Meniscal Injury and Its Effect on Performance in Athletes From the National Basketball Association. Am J Sports Med. Nov 30 2011;[Medline].

  6. Iobst CA, Stanitski CL. Acute knee injuries. Clin Sports Med. Oct 2000;19(4):621-35, vi. [Medline].

  7. Goldstein J, Zuckerman JD. Selected orthopedic problems in the elderly. Rheum Dis Clin North Am. Aug 2000;26(3):593-616. [Medline].

  8. Stanitski CL, Harvell JC, Fu F. Observations on acute knee hemarthrosis in children and adolescents. J Pediatr Orthop. Jul-Aug 1993;13(4):506-10. [Medline].

  9. Yoo JC, Ahn JH, Lee SH, et al. Increasing incidence of medial meniscal tears in nonoperatively treated anterior cruciate ligament insufficiency patients documented by serial magnetic resonance imaging studies. Am J Sports Med. Apr 9 2009;[Medline].

  10. Konan S, Rayan F, Haddad FS. Do physical diagnostic tests accurately detect meniscal tears?. Knee Surg Sports Traumatol Arthrosc. Apr 28 2009;[Medline].

  11. Rinonapoli G, Carraro A, Delcogliano A. The clinical diagnosis of meniscal tear is not easy. Reliability of two clinical meniscal tests and magnetic resonance imaging. Int J Immunopathol Pharmacol. Jan-Mar 2011;24(1 Suppl 2):39-44. [Medline].

  12. Rytter S, Kirkeskov Jensen L, Bonde JP, et al. Occupational kneeling and meniscal tears: a magnetic resonance imaging study in floor layers. J Rheumatol. May 1 2009;[Medline].

  13. Wareluk P, Szopinski KT. Value of modern sonography in the assessment of meniscal lesions. Eur J Radiol. Oct 5 2011;[Medline].

  14. Vance K, Meredick R, Schweitzer ME, et al. Magnetic resonance imaging of the postoperative meniscus. Arthroscopy. May 2009;25(5):522-30. [Medline].

  15. Englund M, Guermazi A, Roemer FW, et al. Meniscal tear in knees without surgery and the development of radiographic osteoarthritis among middle-aged and elderly persons: The Multicenter Osteoarthritis Study. Arthritis Rheum. Mar 2009;60(3):831-9. [Medline].

  16. Church S, Keating JF. Reconstruction of the anterior cruciate ligament: timing of surgery and the incidence of meniscal tears and degenerative change. J Bone Joint Surg Br. Dec 2005;87(12):1639-42.

  17. DeHaven KE. Decision-making factors in the treatment of meniscus lesions. Clin Orthop. Mar 1990;(252):49-54. [Medline].

  18. DeHaven KE, Bronstein RD. Arthroscopic medial meniscal repair in the athlete. Clin Sports Med. Jan 1997;16(1):69-86. [Medline].

  19. Ekstrom JE. Arthrography. Where does it fit in?. Clin Sports Med. Jul 1990;9(3):561-6. [Medline].

  20. Fitzgibbons RE, Shelbourne KD. "Aggressive" nontreatment of lateral meniscal tears seen during anterior cruciate ligament reconstruction. Am J Sports Med. Mar-Apr 1995;23(2):156-9. [Medline].

  21. Fukubayashi T, Kurosawa H. The contact area and pressure distribution pattern of the knee. A study of normal and osteoarthrotic knee joints. Acta Orthop Scand. Dec 1980;51(6):871-9. [Medline].

  22. Greis PE, Bardana DD, Holmstrom MC, et al. Meniscal injury: I. Basic science and evaluation. J Am Acad Orthop Surg. May-Jun 2002;10(3):168-76. [Medline].

  23. Greis PE, Holmstrom MC, Bardana DD, Burks RT. Meniscal injury: II. Management. J Am Acad Orthop Surg. May-Jun 2002;10(3):177-87. [Medline].

  24. Jakob RP, Hassler H, Staeubli HU. Observations on rotatory instability of the lateral compartment of the knee. Experimental studies on the functional anatomy and the pathomechanism of the true and the reversed pivot shift sign. Acta Orthop Scand Suppl. 1981;191:1-32. [Medline].

  25. Kurosawa H, Fukubayashi T, Nakajima H. Load-bearing mode of the knee joint: physical behavior of the knee joint with or without menisci. Clin Orthop Relat Res. Jun 1980;283-90. [Medline].

  26. Lieb FJ, Perry J. Quadriceps function. An anatomical and mechanical study using amputated limbs. J Bone Joint Surg [Am]. Dec 1968;50(8):1535-48. [Medline].

  27. Magee DJ. Examination of the knee. In: Orthopedic Physical Assessment. 3rd ed. Philadelphia, Pa: WB Saunders; 1997:519-77.

  28. McBride ID, Reid JG. Biomechanical considerations of the menisci of the knee. Can J Sport Sci. Dec 1988;13(4):175-87. [Medline].

  29. McCarty EC, Marx RG, Wickiewicz TL. Meniscal tears in the athlete. Operative and nonoperative management. Phys Med Rehabil Clin N Am. Nov 2000;11(4):867-80. [Medline].

  30. Mink JH, Levy T, Crues JV. Tears of the anterior cruciate ligament and menisci of the knee: MR imaging evaluation. Radiology. Jun 1988;167(3):769-74. [Medline]. [Full Text].

  31. Potter HG, Linklater JM, Allen AA, et al. Magnetic resonance imaging of articular cartilage in the knee. An evaluation with use of fast-spin-echo imaging. J Bone Joint Surg Am. Sep 1998;80(9):1276-84. [Medline].

  32. Reicher MA, Hartzman S, Duckwiler GR, et al. Meniscal injuries: detection using MR imaging. Radiology. Jun 1986;159(3):753-7. [Medline]. [Full Text].

  33. Ricklin P, Ruttimann A, Del Buono MS. Meniscus Lesions: Diagnosis, Differential Diagnosis and Therapy. 2nd ed. Thieme Medical Publishers; 1983:16.

  34. Scholten RJ, Deville WL, Opstelten W, et al. The accuracy of physical diagnostic tests for assessing meniscal lesions of the knee: A meta-analysis. J Fam Pract. Nov 2001;50(11):938-44. [Medline].

  35. Stone RG, Frewin PR, Gonzales S. Long-term assessment of arthroscopic meniscus repair: a two- to six-year follow-up study. Arthroscopy. 1990;6(2):73-8. [Medline].

  36. Walker PS, Erkman MJ. Laboratory evaluation of a metal-plastic type of metacarpophalangeal joint prosthesis. Clin Orthop Relat Res. Oct 1975;349-56. [Medline].

  37. Weiss CB, Lundberg M, Hamberg P, et al. Non-operative treatment of meniscal tears. J Bone Joint Surg Am. Jul 1989;71(6):811-22. [Medline].

 
Previous
Next
 
Magnetic resonance imaging scan showing a normal meniscus.
Magnetic resonance imaging scan showing a torn medial meniscus.
Arthroscopic probing of a posterior horn complex meniscal tear with multiple flaps.
Arthroscopic view of medial meniscus after excision of flap tear.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.