eMedicine Specialties > Sports Medicine > Knee

Meniscus Injuries: Differential Diagnoses & Workup

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
Coauthor(s): James Lubowitz, MD, Director, Taos Orthopedic Institute, Holy Cross Hospital of Taos; Clinical Professor, Department of Orthopedic Surgery, University of New Mexico
Contributor Information and Disclosures

Updated: Jun 5, 2008

Differential Diagnoses

Anterior Cruciate Ligament Injury
Medial Synovial Plica Irritation
Contusions
Patellofemoral Joint Syndromes
Iliotibial Band Syndrome
Pes Anserine Bursitis
Knee Osteochondritis Dissecans
Posterior Cruciate Ligament Injury
Lateral Collateral Knee Ligament Injury
Lumbosacral Radiculopathy
Medial Collateral Knee Ligament Injury

Other Problems to Be Considered

Articular cartilage pathology, including arthritis and neoplastic pathology

Crystalline deposition diseases, including gout and pseudogout (chondrocalcinosis)

Ipsilateral hip disease

Osteonecrosis of the femur or tibia

Plica

Secondary gain issues, including workers' compensation claims or pending litigation

Workup

Imaging Studies

  • Plain radiography: An anteroposterior weight-bearing view, posteroanterior 45º flexed view, lateral view, and Merchant patellar view should be obtained to rule out degenerative joint changes (arthritis) or fractures.
  • Arthrography: Historically, arthrography was the standard imaging study for meniscal tears, but it has been replaced by magnetic resonance imaging (MRI).
  • MRI: This is the criterion standard imaging study for imaging meniscus pathology and all intra-articular disorders.11,12
    • Normal menisci have a homogeneous low signal. Abnormal meniscal signals are classified into the following 3 groups:
      • Grade I – Small area of increased signal within the meniscus
      • Grade II – Linear area of increased signal that does not extend to an articulating surface
      • Grade III – Abnormal increased signal that reaches the surface or edge of the meniscus
    • Grade I and II changes are common in older patients as evidence of the normal aging degenerative process and in young patients as normal perforating vascular channels. Grade I and II changes are not usually seen arthroscopically and do not represent meniscal tears. Grade III changes are meniscal tears.
    • MRI has proven to be an effective technique for evaluating menisci.
      • Average sensitivity – 95% medial, 81% lateral
      • Average specificity – 88% medial, 96% lateral
      • Average accuracy – 92% medial, 92% lateral

Procedures

  • Arthroscopy
    • In the hands of a competent arthroscopist, arthroscopy is considered the best tool for meniscal tear diagnosis, with sensitivity, specificity, and accuracy approaching 100%.
    • Arthroscopy is therapeutic and diagnostic and thus offers the advantage of immediate treatment of most disorders.12,13,14

More on Meniscus Injuries

Overview: Meniscus Injuries
Differential Diagnoses & Workup: Meniscus Injuries
Treatment & Medication: Meniscus Injuries
Follow-up: Meniscus Injuries
References
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References

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  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. 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].

  17. 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].

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

  19. 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].

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

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

  22. 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].

  23. 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].

  24. 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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Further Reading

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Keywords

acute meniscal tears, meniscal tear, medial meniscus, lateral meniscus, meniscus tear, meniscal injury, knee injury, meniscectomy, discoid meniscus, McMurray test, Steinmann test, Apley test, Bragard sign, Böhler sign, Payr sign, Merke sign, Childress sign, Finochietto sign

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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 Royalty Consulting; Smith and Nephew Consulting fee Consulting; Breg Grant/research funds Other

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Henry T Goitz, MD, Chief, Sports Medicine, Associate Professor, Department of Orthopaedic Surgery, Medical College of Ohio
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.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, 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, Sports Medicine Fellowship Director, 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, and Wilderness Medical Society
Disclosure: Nothing to disclose.

 
 
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