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Meniscus Injuries Clinical Presentation

  • Author: Bradley S Baker, MD; Chief Editor: Craig C Young, MD  more...
 
Updated: Jul 25, 2016
 

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 usually the result of synovitis or abnormal motion of the unstable meniscus fragment.
    • The pain is usually localized to the joint line. Meniscal root tears usually cause posterior knee pain.
  • Mechanical complaints: Patients often provide nonspecific descriptions, but these include reports of clicking, catching, locking, pinching, or a sensation of giving way. Root tears however, rarely cause mechanical symptoms.[12]
  • 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.[13] 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.
      • Only 57% of meniscal root tears result in a positive McMurray test.[12]
    • The Steinmann test
      • Tibial rotation is performed with the patient seated and the knee flexed 90º. 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 90º. 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.
    • The Thessaly test
      • This maneuver is performed with the patient standing on one leg and the knee flexed to 5º and 20º while holding the examiner’s hand for balance. From this position, the patient is asked to internally and externally rotate the knee. Pain or a locking or catching sensation at the medial or lateral joint line is suggestive of meniscal tears.
    • 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, Mid-America Orthopaedic Association, Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Coauthor(s)

James H Lubowitz, MD Director, Taos Orthopaedic Institute, Taos Orthopaedic Institute Research Foundation (TOIRF), and Taos Orthopaedic Institute Sports Medicine Fellowship Training Program; Clinical Professor, Department of Orthopaedic Surgery, University of New Mexico School of Medicine

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

Disclosure: Received consulting fee from Arthrex for consulting; Received salary from AANA for employment; Received royalty from Arthrex for other.

Bryce T Wolf, MD Sports Medicine Fellow, Taos Orthopedic Institute

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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, American Orthopaedic Society for Sports Medicine

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, 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, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

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.

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Magnetic resonance imaging scan showing a normal meniscus.
Magnetic resonance imaging scan showing a torn medial meniscus.
 
 
 
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