Meniscus Injuries Clinical Presentation

  • Author: Bradley S Baker, MD; Chief Editor: Craig C Young, MD   more...
 
Updated: Mar 22, 2011
 

History

Most meniscal injuries can be diagnosed by obtaining a detailed history. Important points to address include the following:

  • Mechanism of injury
    • Meniscus tears are sometimes related to trauma, but significant trauma is not necessary. A sudden twist or repeated squatting can tear the meniscus. The timing of the injury is important to note, although patients often cannot describe a specific event.
    • Meniscus tears typically occur as a result of twisting or change of position of the weight-bearing knee in varying degrees of flexion or extension.
  • Pain
    • Pain from meniscus injuries is commonly intermittent and is usually the result of synovitis or abnormal motion of the unstable meniscus fragment.
    • The pain is usually localized to the joint line.
  • Mechanical complaints: Descriptions by patients are often nonspecific but include reports of clicking, catching, locking, pinching, or a sensation of giving way.
  • Swelling
    • Swelling usually occurs as a delayed symptom or may not occur at all. Immediate swelling indicates a tear in the peripheral vascular aspect.
    • Degenerative tears often manifest with recurrent effusions due to synovitis.
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Physical

A complete examination, including that of the lower spine, ipsilateral hip and thigh, patellofemoral joint, and tibiofemoral joint, is essential when evaluating knee pain. Associated findings such as a perimeniscal cyst or ligamentous laxity suggest a higher likelihood of a meniscus injury. Important findings when examining a patient with a possible meniscus injury include the following:

  • Joint line tenderness
    • Joint line tenderness is an accurate clinical sign.[10] This finding indicates injury in 77-86% of patients with meniscus tears. Despite the high predictive value, operative findings occasionally differ from the preoperative assessment.
    • The examiner must differentiate collateral ligament tenderness that may extend further toward the ligament attachment sites, above and below the joint line.
  • Effusion
    • Effusion occurs in approximately 50% of the patients presenting with a meniscus tear.
    • The presence of an effusion is suggestive of a peripheral tear in the vascular or red zone (especially when acute), an associated intra-articular injury, or synovitis.
  • Range of motion
    • A mechanical block to motion or frank locking can occur with displaced tears.
    • Restricted motion caused by pain or swelling is also common.
  • Provocative maneuvers: These techniques cause impingement by creating compression and/or shearing forces on the torn meniscus between the femoral and tibial surfaces.
    • The McMurray test
      • This maneuver usually elicits pain or a reproducible click in the presence of a meniscal tear. The medial meniscus is evaluated by extending the fully flexed knee with the foot/tibia internally rotated while a varus stress is applied. The lateral meniscus is evaluated by extending the knee from the fully flexed position, with the foot/tibia externally rotated while a valgus stress is applied to the knee. One of the examiner's hands should be palpating the joint line during the maneuver.
    • The Steinmann test,
      • Tibial rotation is performed with the patient seated and the knee flexed 90 º. Asymmetric pain is created with external (medial meniscus) or internal (lateral meniscus) rotation.
    • The Apley test
      • This maneuver is performed with the patient prone and the knee flexed 90 º. An axial load is applied through the heel as the lower leg is internally and externally rotated. This grinding maneuver is suggestive of meniscal pathology if pain is elicited at the medial or lateral joint.
    • Similar tests, including those that elicit the Bragard sign, Böhler sign, Payr sign, Merke sign, Childress sign, and Finochietto sign, are based on the provocative principle.
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Contributor Information and Disclosures
Author

Bradley S Baker, MD  Clinical Professor, Department of Orthopedic Surgery and Orthopedic Sports Medicine, Sanford School of Medicine, University of South Dakota; Orthopedic Consultant/Team Physician, Sanford Sports Medicine

Bradley S Baker, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Sports Medicine, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and Mid-America Orthopaedic Association

Disclosure: Nothing to disclose.

Coauthor(s)

James Lubowitz, MD  Director, Taos Orthopedic Institute, Holy Cross Hospital of Taos; Clinical Professor, Department of Orthopedic Surgery, University of New Mexico

James Lubowitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and Arthroscopy Association of North America

Disclosure: Arthrex Consulting and royalty Consulting; Smith and Nephew Consulting fee Consulting; Breg Grant/research funds Other

Specialty Editor Board

Leslie Milne, MD  Assistant Clinical Instructor, Department of Emergency Medicine, Harvard University School of Medicine

Leslie Milne, MD is a member of the following medical societies: American College of Sports Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Henry T Goitz, MD  Academic Chair and Associate Director, Detroit Medical Center Sports Medicine Institute; Director, Education, Research, and Injury Prevention Center; Co-Director, Orthopaedic Sports Medicine Fellowship

Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Orthopaedic Society for Sports Medicine

Disclosure: Nothing to disclose.

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD  Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Director of Primary Care Sports Medicine Fellowship, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, and Phi Beta Kappa

Disclosure: Nothing to disclose.

References

  1. Bland-Sutton J. Ligaments: Their Nature and Morphology. 2nd ed. London, UK: HK Lewis; 1887.

  2. Fairbanks TJ. Knee joint changes after meniscectomy. J Bone Joint Surg Br. 1948;30:664-70. [Full Text].

  3. Arendt EA, ed. Orthopaedic Knowledge Update: Sports Medicine 2. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1999.

  4. Insall JN, Scott WN, eds. Surgery of the Knee. 3rd ed. Philadelphia, Pa: WB Saunders Co; 2001.

  5. Rodkey WG. Basic biology of the meniscus and response to injury. Instr Course Lect. 2000;49:189-93. [Medline].

  6. Fu FH, Harner CD, Vince KG, eds. Knee Surgery. Philadelphia, Pa: Lippincott Williams & Wilkins; 1994.

  7. Arnoczky SP, Warren RF. The microvasculature of the meniscus and its response to injury. An experimental study in the dog. Am J Sports Med. May-Jun 1983;11(3):131-41. [Medline].

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

  9. Vaziri A, Nayeb-Hashemi H, Singh A, Tafti BA. Influence of meniscectomy and meniscus replacement on the stress distribution in human knee joint. Ann Biomed Eng. May 22 2008;epub ahead of print. [Medline].

  10. Eren OT. The accuracy of joint line tenderness by physical examination in the diagnosis of meniscal tears. Arthroscopy. Oct 2003;19(8):850-4. [Medline].

  11. Behairy NH, Dorgham MA, Khaled SA. Accuracy of routine magnetic resonance imaging in meniscal and ligamentous injuries of the knee: comparison with arthroscopy. Int Orthop. May 28 2008;epub ahead of print. [Medline].

  12. Nikolaou VS, Chronopoulos E, Savvidou C, et al. MRI efficacy in diagnosing internal lesions of the knee: a retrospective analysis. J Trauma Manag Outcomes. Jun 2 2008;2(1):4. [Medline].

  13. Spindler KP, McCarty EC, Warren TA, Devin C, Connor JT. Prospective comparison of arthroscopic medial meniscal repair technique: inside-out suture versus entirely arthroscopic arrows. Am J Sports Med. Nov-Dec 2003;31(6):929-34. [Medline].

  14. Bin SI, Kim JM, Shin SJ. Radial tears of the posterior horn of the medial meniscus. Arthroscopy. Apr 2004;20(4):373-8. [Medline].

  15. Shelbourne KD, Heinrich J. The long-term evaluation of lateral meniscus tears left in situ at the time of anterior cruciate ligament reconstruction. Arthroscopy. Apr 2004;20(4):346-51. [Medline].

  16. Nicholas SJ, Golant A, Schachter AK, Lee SJ. A new surgical technique for arthroscopic repair of the meniscus root tear. Knee Surg Sports Traumatol Arthrosc. Dec 2009;17(12):1433-6. [Medline].

  17. Logan M, Watts M, Owen J, Myers P. Meniscal repair in the elite athlete: results of 45 repairs with a minimum 5-year follow-up. Am J Sports Med. Jun 2009;37(6):1131-4. [Medline].

  18. Kim SB, Ha JK, Lee SW, Kim DW, Shim JC, Kim JG, et al. Medial meniscus root tear refixation: comparison of clinical, radiologic, and arthroscopic findings with medial meniscectomy. Arthroscopy. Mar 2011;27(3):346-54. [Medline].

  19. Adachi N, Ochi M, Uchio Y, Kuriwaka M, Shinomiya R. Torn discoid lateral meniscus treated using partial central meniscectomy and suture of the peripheral tear. Arthroscopy. May 2004;20(5):536-42. [Medline].

  20. Kelly JD 4th, Ebrahimpour P. Chondral injury and synovitis after arthroscopic meniscal repair using an outside-in mulberry knot suture technique. Arthroscopy. May 2004;20(5):e49-52. [Medline].

  21. Barber FA, Harding NR. Meniscal repair rehabilitation. Instr Course Lect. 2000;49:207-10. [Medline].

  22. Choi NH, Kim TH, Victoroff BN. Comparison of arthroscopic medial meniscal suture repair techniques: inside-out versus all-inside repair. Am J Sports Med. Nov 2009;37(11):2144-50. [Medline].

  23. Hart ES, Kalra KP, Grottkau BE, Albright M, Shannon EG. Discoid lateral meniscus in children. Orthop Nurs. May/June 2008;27(3):174-9. [Medline].

  24. Cox CL, Deangelis JP, Magnussen RA, Fitch RW, Spindler KP. Meniscal tears in athletes. J Surg Orthop Adv. Spring 2009;18(1):2-8. [Medline].

  25. Ding J, Zhao J, He Y, Huangfu X, Zeng B. Risk factors for articular cartilage lesions in symptomatic discoid lateral meniscus. Arthroscopy. Dec 2009;25(12):1423-6. [Medline].

  26. Freedman KB, Nho SJ, Cole BJ. Marrow stimulating technique to augment meniscus repair. Arthroscopy. Sep 2003;19(7):794-8. [Medline].

  27. Iwamoto J, Takeda T, Sato Y, Matsumoto H. Retrospective case evaluation of gender differences in sports injuries in a Japanese sports medicine clinic. Gend Med. Dec 2008;5(4):405-14. [Medline].

  28. Jerosch J, Riemer S. [How good are clinical investigative procedures for diagnosing meniscus lesions?] [German]. Sportverletz Sportschaden. Jun 2004;18(2):59-67. [Medline].

  29. Kisiday JD, Vanderploeg EJ, McIlwraith CW, Grodzinsky AJ, Frisbie DD. Mechanical injury of explants from the articulating surface of the inner meniscus. Arch Biochem Biophys. Nov 24 2009;epub ahead of print. [Medline].

  30. Metcalf MH, Barrett GR. Prospective evaluation of 1485 meniscal tear patterns in patients with stable knees. Am J Sports Med. Apr-May 2004;32(3):675-80. [Medline].

  31. Oei EH, Koster IM, Hensen JH, et al. MRI follow-up of conservatively treated meniscal knee lesions in general practice. Eur Radiol. Nov 17 2009;epub ahead of print. [Medline].

  32. Pearse EO, Craig DM. Partial meniscectomy in the presence of severe osteoarthritis does not hasten the symptomatic progression of osteoarthritis. Arthroscopy. Nov 2003;19(9):963-8. [Medline].

  33. Uysal M, Akpinar S, Bolat F, et al. Apoptosis in the traumatic and degenerative tears of human meniscus. Knee Surg Sports Traumatol Arthrosc. Apr 30 2008;epub ahead of print. [Medline].

 
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