Meniscal Tears

  • The menisci are two crescent-shaped fibrocartilaginous discs that sit within the knee joint.

  • They transfer loads across the joint, lubricate and stabilise the joint, and act as shock absorbers.

  • Meniscal tears commonly occur in activities that involve rotation of the knee or squatting, but often the patient will not be aware of an actual injury.

Subjective History:

In sport, the mechanism of injury is usually non-contact and related to a change of direction, deceleration or landing from a jump. The patient may have heard or felt a pop at the time, which could suggest an associated knee ligament tear, particularly of the ACL.
The menisci can become degenerative with age, so patients over 40 will often be symptomatic without being able to remember any specific injury (see advice on degenerative meniscus for additional information).
Most tears lead to swelling for several days after injury, which may be worsened by activity.
Mechanical symptoms of popping, catching, locking, or giving way, along with joint line pain are suggestive of meniscal tear.
Objective Examination:

Antalgic gait
Reduced active and passive range of movement with pain at end of range
Joint line tenderness
The patient will often have reduced thigh muscle mass and swelling of the affected knee
Special tests include Apley’s and McMurray’s.
References

Image from OpenI – Licensed by CC

If you feel that your patient has suffered a meniscal tear, please refer them to physiotherapy. We can work with the patient to return them to function through:

Rest, ice compression and elevation
Strengthening local musculature, particularly the quadriceps
Restoring range of movement
In certain cases, appropriate onward referral for consideration of surgery
If referred to Physiotherapy via the acute knee pathway (West Suffolk CCG only), the patient will be seen within 72 hours of referral

References

Image from OpenI – Licensed by CC