Signs and Symptoms of Meniscal Tears
Meniscal tears typically present with joint line pain, catching or locking sensations, and effusion, although these "mechanical symptoms" may actually be more associated with underlying cartilage damage rather than the meniscal tear itself. 1
Key Clinical Presentation
Pain Characteristics
- Joint line tenderness (83% sensitivity, 83% specificity) 2
- Activity-related pain, especially with twisting or pivoting movements
- Pain that worsens with deep knee flexion (squatting, kneeling)
- Pain that may be localized to the medial or lateral joint line depending on which meniscus is torn
Mechanical Symptoms
- Catching or locking sensations (may indicate a displaced tear)
- Clicking, grinding, or popping sounds during knee movement
- Sense of knee "giving way" or buckling
- Feeling of instability during weight-bearing activities
Physical Examination Findings
- Joint effusion (swelling)
- Limited range of motion
- McMurray test: positive with concurrent knee rotation and extension (61% sensitivity, 84% specificity) 2
- Positive findings on special tests:
- Apley's test
- Thessaly test
- Duck waddle test
Important Diagnostic Considerations
Age-Related Differences
- Younger patients (<40 years): Tears often result from acute trauma or twisting injuries 2
- Older patients (≥40 years): Tears are frequently degenerative and may coexist with osteoarthritis 2
Types of Tears and Associated Symptoms
- Bucket-handle tears: More likely to cause true locking of the knee
- Flap tears: Often associated with catching sensations
- Degenerative tears: May cause more diffuse symptoms and coexist with osteoarthritis
Diagnostic Pitfalls
- Recent research indicates that traditionally defined "meniscal" and "mechanical" symptoms (catching, locking, grinding) may actually be more strongly associated with cartilage damage than with meniscal pathology 1
- Meniscal tears are common incidental findings on MRI in middle-aged and elderly people, with approximately one-third having damage that may not cause symptoms 3
- Careful clinical evaluation is essential to determine if symptoms are directly related to the meniscal tear 3
Diagnostic Approach
- Clinical diagnosis based on history and physical examination
- MRI is often needed to confirm tears and differentiate from other causes of knee pain 4
- Radiography is the initial imaging method for suspected chondrocalcinosis of the menisci 5
Management Implications
- Conservative management should be first-line treatment for most meniscal tears 5
- Surgical intervention should only be considered when:
- Conservative management has failed after 6-8 weeks
- Symptoms significantly impact quality of life
- Patient has true mechanical symptoms, especially a locked knee 5
Remember that while these signs and symptoms are suggestive of meniscal tears, they may overlap with other knee pathologies, and careful clinical assessment is essential for accurate diagnosis and appropriate management.