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Key Features

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  • Most injuries are related to directional changes on a weight-bearing extremity

  • Medial meniscus injuries

    • Have a history of tibial rotation in a weight-bearing position

    • Injury happens frequently in ball-handling sports

  • Lateral meniscus injuries

    • Occur with tibial rotation with a flexed knee, as in exercises such as squatting or certain wrestling maneuvers

    • Injuries are uncommon in children younger than 10 years

  • Patients who have undergone meniscectomy (removal of torn tissue) can often return to sports 3–6 weeks after surgery

  • Patients who have had meniscal repair require 6 weeks of crutch protection followed by physical therapy

  • Return to sport after a repair is typically 3–4 months

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Clinical Findings

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  • History of knee pain, swelling, snapping, or locking and may report a feeling of the knee giving way

  • Effusion

  • Joint line tenderness

  • McMurray hyperflexion-rotation test

    • Test is performed by having the examiner place his/her fingers across the joint lines while flexing the knee maximally

    • The knee is then rotated while it is brought out into extension

    • A positive test is evoked when the patient reports pain and the examiner feels an associated click or catch along the joint line

  • Thessaly test

    • Test is performed by having the patient stand on the injured leg

    • Examiner supports the patient by holding his or her outstretched arms

    • Patient is instructed to flex the knee to 5 degrees and then rotate his or her body and knee internally and externally three times

    • This is repeated with the knee at 20 degrees of flexion

    • A test is positive if the patient has joint line pain or a sense of locking or catching in the knee

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Diagnosis

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  • Diagnostic test of choice is MRI of the knee, although standard knee radiographs should be included

  • It is important to note that the increased vascularity of the meniscus in the pediatric population often causes increased signal changes on MRI that can be confused with a tear

  • Therefore, an MRI diagnosis of a meniscal tear in a young athlete needs to be correlated with the patient's clinical symptoms and examination

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Treatment

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  • Nonoperative management can be considered if the tear is minor and symptoms are minimal

  • However, injury typically requires surgery

    • Can entail repairing the tear or removing the torn portion of the meniscus

    • Typically, every attempt is made to preserve the meniscal tissue in young athletes because of their favorable healing rates and the long-term concern over the development of arthritis in meniscal deficient patients

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