LESIONS OF THE MENISCI

ROSSHINI JAGATHESWARAN

6/3/2014 1

Tears of the meniscus

More likely to tear along its length

6/3/2014 2

Mechanism of InjuryRotational grinding force (knee flexed and twisted while taking weight – footballers)Common in medial meniscus

ClassificationVertical/LongitudinalHorizontal Radial

6/3/2014 3

Vertical/longitudinal tears

Most commonAnterior horn tearPosterior horn tearBucket-handle tear

6/3/2014 4

Horizontal tearsDegenerativeRepetitive minor traumaMay progress to flap tear

Radial tearsrun from inner edge of the meniscus to the outer bodyParrot beak tear -incomplete

Flap tear

Parrot-beak tear

6/3/2014 5

Clinical FeaturesUsually a young personTwisting injurySports injury

SymptomsPainAvoids further activityLocking of the knee in partial flexion (DIAGNOSTIC)SwellingRecur periodically after trivial twists and strains

6/3/2014 6

SignsJoint may be held slightly flexedEffusion of the knee – patellar tap positiveWasting of quadricepsTenderness localised to joint lineFull flexion but limited extensionMcMurray’s test positiveApley’s grinding test positiveThessaly test positive

6/3/2014 8

Differences between hemarthrosis and effusion

Hemarthrosis Effusion

Swelling seen immediately after injury

Swelling presents later after injury

Cruciate or peripheral meniscal lesion in the absence of a fracture

Tear of the inner meniscus or synovial irritation

Patella tap positive

6/3/2014 9

McMurray’s Test–Lateral Meniscus

Patient supineKnee completely flexedGrasp the ankle (lower tibia) firmly with one hand and the knee (lateral joint line) with the otherFoot internally rotatedExtend the knee with a varus force to knee As femur passes over the torn meniscus : pain / clicking sound

6/3/2014 10

McMurray’s Test – Medial Meniscus

Patient supineKnee completely flexedGrasp the ankle (lower tibia) firmly with one hand and the knee (medial joint line) with the otherFoot externally rotatedExtend the knee with a valgus force to knee As femur passes over the torn meniscus : pain / clicking sound

6/3/2014 11

Apley’s grinding test

Patient proneKnee flexed to 90 degreesKnee rotatedCompression force appliedPain indicates torn meniscus

6/3/2014 13

Thessaly Test

Patient stands flat footed on one leg Examiner hold his/her handsFlex the affected knee to 20 degrees Ask patient to twist body side to side thricePain at medial or lateral joint lines, locking – meniscal tear

6/3/2014 14

InvestigationsPlain X-raysMagnetic Resonance Imaging (MRI)Arthroscopy

6/3/2014 15

MRI Findings

6/3/2014 17

• Arthroscopy

6/3/2014 18

Differential Diagnosis

Loose bodiesRecurrent dislocation of patellaFracture of tibial spinePartial tear of medial collateral ligamentTorn anterior cruciate ligament

6/3/2014 19

Tears of the meniscus

TreatmentDealing with the locked knee•Gentle passive flexion and rotationConservative•After an cute episode, joint held straight in plaster backslab for 3-4 weeks•Crutches and quadriceps exercise•RICE protocolOperative•Indicated if joint cannot be unlocked and symptoms are recurrent6/3/2014 20

THANK YOU

6/3/2014 22