From the Guidelines
Meniscal injuries typically present with joint line pain, swelling, catching or locking of the knee, and limited range of motion, as reported in patients with knee symptoms, such as pain, swelling, locking, catching, popping, or giving way, and/or signs, including tenderness, effusion, loss of motion, or crepitus 1. The classic signs of meniscal injuries include:
- Joint line tenderness
- Positive McMurray test, which is pain or clicking when rotating the tibia while extending the knee from a flexed position
- Positive Thessaly test, which is pain when standing on the affected leg and rotating the knee Swelling usually develops gradually over 24-48 hours rather than immediately. Patients often report a specific twisting injury or may have degenerative tears from normal wear and tear, especially in older adults. According to a study published in the Journal of the American College of Radiology, MRI has many distinct advantages for the evaluation of the injured knee in the setting of negative radiographs, allowing for earlier surgical intervention by obtaining a more accurate diagnosis 1. The study also reported that MRI can diagnose the patterns and severity of bone marrow contusions that frequently have an association with the specific mechanisms of injury and can predict associated soft-tissue injuries. Additionally, MRI can change management from surgical to conservative in up to 48% of patients presenting with a locked knee, which is usually an indication for arthroscopic procedure 1. Treatment depends on the location and severity of the tear, and conservative management includes rest, ice, compression, elevation (RICE), NSAIDs like ibuprofen for pain and inflammation, and physical therapy focusing on quadriceps and hamstring strengthening. For tears in the vascular "red zone" of the meniscus, healing is possible, while tears in the avascular "white zone" typically don't heal well. Surgical intervention with arthroscopic repair or partial meniscectomy may be necessary for persistent symptoms, mechanical locking, or large unstable tears. Early diagnosis and appropriate management are crucial to prevent long-term knee instability and premature osteoarthritis. It is essential to note that the strength of recommendation for radiographs in patients with knee symptoms is weak, and the level of evidence is a level II study 1. However, the study published in the Journal of the American College of Radiology provides more recent and higher-quality evidence, supporting the use of MRI in the evaluation of meniscal injuries 1.
From the Research
Signs and Symptoms of Meniscal Injury
- Knee pain, particularly with twisting or rotational movements 2
- Limited range of motion (ROM) in the knee joint 3
- Joint instability or feeling of the knee giving way 4
- Swelling or inflammation in the knee area 2
- Locking or catching sensation in the knee joint 5
Diagnosis and Management
- Diagnostic workup, including magnetic resonance imaging (MRI), to confirm meniscus tear 3
- Conservative management with RICE protocol (rest, ice, compression, elevation) and physical therapy 3
- Therapeutic ultrasound to decrease pain and increase ROM of the knee 3
- Arthroscopic surgery to address meniscal tears, with rehabilitation playing a crucial role in functional outcome 4
Rehabilitation and Return to Play
- Rehabilitation programs to promote functional gains and prevent degenerative changes 4, 6
- Knee motion and quadriceps-strengthening exercises initiated postoperatively 5
- Gradual progression of weight-bearing and joint compressive forces to prevent disruption of meniscus repair or transplant 5
- Evidence-based rehabilitation and return-to-play guidelines to optimize outcomes following meniscal surgery 6