Meniscus Injuries Clinical Presentation

Updated: Oct 12, 2018
  • Author: Bradley S Baker, MD; Chief Editor: Craig C Young, MD  more...
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Presentation

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.

Next:

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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