Briefly presented on meniscal tear, the tests done, and treatment

1. LESIONS OF THE MENISCI
ROSSHINI JAGATHESWARAN
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2. Tears of the meniscus
More likely to tear along its length
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3. Mechanism of Injury
Rotational grinding force (knee flexed and
twisted while taking weight – footballers)
Common in medial meniscus
Classification
Vertical/Longitudinal
Horizontal
Radial
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4. Vertical/longitudinal tears
Most common
Anterior horn tear
Posterior horn tear
Bucket-handle tear
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5. Horizontal tears
Degenerative
Repetitive minor trauma
May progress to flap
tear
Radial tears
run from inner edge of
the meniscus to the outer
body
Parrot beak tear
-incomplete
Flap tear
Parrot-beak tear
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6. Clinical Features
Usually a young person
Twisting injury
Sports injury
Symptoms
Pain
Avoids further activity
Locking of the knee in partial flexion (DIAGNOSTIC)
Swelling
Recur periodically after trivial twists and strains
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7. Signs
Joint may be held slightly flexed
Effusion of the knee – patellar tap positive
Wasting of quadriceps
Tenderness localised to joint line
Full flexion but limited extension
McMurray’s test positive
Apley’s grinding test positive
Thessaly test positive
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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
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9. McMurray’s Test–Lateral Meniscus
Patient supine
Knee completely flexed
Grasp the ankle (lower tibia) firmly with one hand
and the knee (lateral joint line) with the other
Foot internally rotated
Extend the knee with a varus force to knee
As femur passes over the torn meniscus : pain /
clicking sound
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10. McMurray’s Test – Medial Meniscus
Patient supine
Knee completely flexed
Grasp the ankle (lower tibia) firmly with one hand
and the knee (medial joint line) with the other
Foot externally rotated
Extend the knee with a valgus force to knee
As femur passes over the torn meniscus : pain /
clicking sound
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11. Apley’s grinding test
Patient prone
Knee flexed to 90 degrees
Knee rotated
Compression force applied
Pain indicates torn meniscus
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12. Thessaly Test
Patient stands flat footed on
one leg
Examiner hold his/her hands
Flex the affected knee to 20
degrees
Ask patient to twist body side
to side thrice
Pain at medial or lateral joint
lines, locking – meniscal tear
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13. Investigations
Plain X-rays
Magnetic Resonance Imaging
(MRI)
Arthroscopy
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14. MRI Findings
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15. • Arthroscopy
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16. Differential Diagnosis
Loose bodies
Recurrent dislocation of patella
Fracture of tibial spine
Partial tear of medial collateral ligament
Torn anterior cruciate ligament
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17. Tears of the meniscus
Treatment
Dealing with the locked knee
•Gentle passive flexion and rotation
Conservative
•After an cute episode, joint held straight in plaster
backslab for 3-4 weeks
•Crutches and quadriceps exercise
•RICE protocol
Operative
•Indicated if joint cannot be unlocked and
symptoms are recurrent
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18. THANK YOU
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