- Onset: may be sudden, but will be atraumatic or minimal trauma in the older age groups.
- Normal age group 40-60.
- Pain localised to Tibiofemoral joint line.
- May complain of clicking and locking (important to establish if ‘true’, degenerative meniscal tears are normally horizontal and therefore locking is rare in this group).
- Not normally a loss of motion, unless true locking, but often pain on overpressure end range flexion or extension, depending on site of lesion (e.g. Anterior or Posterior horn)
- Palpation: concordant pain over Tibiofemoral joint line palpated with the knee flexed 45-90 degrees
Indication for onward orthopaedic referral would be if the knee is truly locking the patient relative or another person has to manual unlock (not just a knee which is stiff after sitting)
Refer to Physiotherapy:
- Initial management should involve protection, rest, ice, compression and elevation (PRICE).
- Painful activities should be avoided
- Avoid deep squatting as this is likely to cause pain.
- Active pain-free exercises (gentle range of movement)
After the first 48 hrs:
- Gradually increase strength:
- Quads strengthening
- Initially straight leg raise as this can activate quads without causing pain in the knee
- progress to weight bearing and stability exercises (pain free)
- Pool running
- Swimming not breast stroke legs
If not improving after 6 months of conservative measure consider referral on to the orthopaedic team.