From the Guidelines
Meniscal knee injuries typically present with specific clinical features, including pain along the joint line, mechanical symptoms such as catching or locking, and joint line tenderness, which are crucial for diagnosis and management. The clinical presentation of meniscal knee injuries can vary depending on the location and severity of the tear. According to 1, MRI has been shown to be a valuable tool in the diagnosis of meniscal tears, with high sensitivity and specificity. The study by Magee and Williams 1 reported 96% sensitivity and 97% specificity of 3T MRI in the detection of meniscal tears in correlation with arthroscopy.
Some key clinical features of meniscal knee injuries include:
- Pain along the joint line, usually localized to either the medial or lateral aspect of the knee
- Mechanical symptoms such as catching, locking, or giving way of the knee during movement
- Swelling that may develop gradually over 24-48 hours
- Joint line tenderness on examination
- Positive McMurray's test or Apley's test supporting the diagnosis
- Limited range of motion, particularly with flexion
- A positive Thessaly test may reproduce symptoms
It is essential to note that the clinical features of meniscal knee injuries can vary depending on the location and severity of the tear, with acute traumatic tears typically causing more pronounced symptoms than degenerative tears in older adults. As stated in 1, meniscus tears in patients with knee osteoarthritis are a challenging clinical complication, and the majority of patients with knee osteoarthritis are unlikely to get much improvement from surgical treatment of the meniscus tear. However, a small number of truly obstructing displaced meniscus tears may warrant treatment. The diagnosis and management of meniscal knee injuries should be guided by a combination of clinical evaluation and imaging studies, such as MRI, to ensure optimal outcomes and minimize morbidity and mortality.
From the Research
Clinical Features of Meniscal Knee Injury
- Meniscal tears can be managed through conservative physical therapy and nonsteroidal anti-inflammatory medications or operative intervention 2
- The most frequent treatment is partial resection of the meniscus, or meniscectomy, which can affect joint mechanics and health 3
- Meniscal repair is superior to partial meniscectomy with better functional outcomes and less severe degenerative changes over time 2
- Meniscal repair shows 80% success at 2 years and is more suitable in younger patients with reducible tears that are peripheral and horizontal or longitudinal in nature 4
Diagnosis and Treatment
- MRI is the imaging modality of choice for diagnosing meniscal tears 5
- Arthroscopic partial meniscectomy (APM) is currently the most performed orthopedic procedure, but recent studies have shown that outcomes after APM are no better than the outcomes after a sham/placebo surgery 5
- Meniscal repair is now being touted as a viable and effective alternative to partial meniscectomy, especially in young and physically active patients 5
- Preservation of the meniscus should be considered as the first line of treatment because of an inferior clinical and radiological long-term outcome after partial meniscectomy compared to meniscus repair 6
Meniscal Tear Classifications and Treatment Approaches
- Meniscal tear classifications and prevalence are important factors in determining the most appropriate treatment approach 3
- Biologic augmentation and material-based systems are being developed to promote meniscal healing and improve meniscal repair outcomes 3
- Novel tissue adhesives may provide the mechanical integrity that the meniscus requires for effective repair 3
- The European Society for Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) consensus recommends preservation of the meniscus as the first line of treatment, and that numerous meniscus tears that were considered irreparable should be repaired 6