Meniscus Injuries Workup

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

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  • Arthrography: Historically, arthrography was the standard imaging study for meniscal tears, but it has been replaced by magnetic resonance imaging (MRI).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
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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]
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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.

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