Meniscal Injuries

Key Features

• 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

Clinical Findings

• 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

Diagnosis

• 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

Treatment

• 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