Nov 18, 2014 traditionally, sonography has had low utilization as a tool in the diagnosis of degenerative meniscal pathology. Optimal diagnosis and management is essential to prevent long term sequelae. As per the original guidelines, these revised guidelines are primarily aimed at the diagnosis, evaluation, assessment, and treatment interventions of meniscal and articular cartilage lesions with respect to. Association of mri findings and expert diagnosis of. This booklet gives information on the different types of meniscus problems, the evidencebased management options, and how physiotherapy can help. Does this patient have a torn meniscus or ligament of the. Meniscal tears are mainly either traumatic or degenerative. These lesions generally occur when a patient attempts to run, twist, or change directions when weight bearing. Often times these tears can be diagnosed by taking a thorough history and completing a physical examination. Meniscus tears are among the most common knee injuries. The medial meniscus is semicircular in shape and the lateral meniscus is almost a. Risk factors, diagnosis and nonsurgical treatment for. The accuracy of joint line tenderness by physical examination. Feb 01, 2012 a combination of historical features and examination findings will help alert physicians to the possibility of meniscal tear more than the results of any one test.
In fact, a meniscal tear is one of the most frequently occurring cartilage injuries. The lateral meniscus covers 84% of the lateral tibial plateau. See medial collateral ligament injury of the knee and anterior cruciate ligament injury. To avoid errors in diagnosing meniscal tears, those interpreting mr examinations of the knee need to be aware of the attachments of the menisci and the normal variations in meniscal anatomy that may resemble a meniscal tear. Often times these tears can be diagnosed by taking a thorough history and completing. There are two menisci in each knee joint they can be damaged or torn during. Like a lot of knee injuries, a meniscus tear can be painful and debilitating.
Meniscal tears are the failure of the fibrocartilaginous menisci of the knee. The accuracy of joint line tenderness by physical examination in the diagnosis of meniscal tears. Generally, when someone has a torn meniscus there is significant pain at. Tears are usually described by where they are located. Presentation, diagnosis and management article pdf available in australian family physician 414. Mr imagingbased diagnosis and classification of meniscal tears. Pdf medial and lateral knee joint menisci serve to transfer load and absorb shock, aid joint stability and provide lubrication. Meniscal tear one of the most commonly injured parts of the knee, the meniscus is a wedgelike rubbery cushion where the major bones of your leg connect. Younger and elderly patients typically sustain different types of tears. Meniscal tears can occur when the knee is forcefully twisted, sustains a direct blow, deep squatting or during activities that require changing directions. Anatomic variants and pitfalls that can mimic a tear include discoid meniscus, meniscal flounce, a meniscal ossicle, and chondrocalcinosis. Meniscal tear symptoms, diagnosis and treatment bmj best. Acute meniscal pathology presents with a history of a twisting injury, mild joint effusion, and pain localized to the affected. Arthroscopic surgery to address the menisci is the most frequently performed procedure on the knee and one of the most regularly performed surgeries in or.
Mri diagnosis of meniscal lesions in correlation with their site phmm ahmm phlm ahlm n % n % n % n % normal 0 0. Child developmentinjuries 182 reprinted from australian family physician vol. Or a tear can occur across the center of the meniscus. Diagnosing a meniscal tear clinically is a challenge as several different diagnostic tests exist and the positive ppv and negative predictive values npv of these tests depend on the prevalence of meniscal tears, which varies according to age. Tears may lead to degenerative, arthritic changes if not already present. Value of history, physical examination, and radiographic. Radiographic findings in the diagnosis of symptomatic meniscal tear among middleaged subjects with knee pain jeffrey n. In the remaining 5% of patients, it is not possible to be definitive but a. A preoperative diagnosis of a medial meniscal tear was made in 54 knees and 32 were confirmed at arthroscopy. Its investigation and treatment includes surgical techniques that are among the most.
These lesions generally occur when a patient attempts to run, twist, or change directions when weight. It is well established that meniscal damage predisposes the adjacent articular cartilage to increased axial and sheer stress, resulting in early degenerative osteoarthritis. Meniscal tears among the most common of knee injuries mayo. There are several types and can occur in an acute or chronic setting. Diagnosis of a meniscal tear can commonly be made with history and physical. Diagnosis and management of meniscal injury jacob babu, md, mha. Diagnosis and management of meniscal injury rhode island. A torn meniscus is damage from a tear in the cartilage that is positioned on top of the tibia to allows the femur to glide when the knee joint moves.
Patients and methods this study included 50 patients, presented by pain, swelling, stiffnesslimitation of movement or a history of acutechronic knee. These changes in the meniscus are best called wear and tear, since they often dont result from a single injury and may have no symptoms. As per the original guidelines, these revised guidelines are primarily aimed at the diagnosis, evaluation, assessment, and treatment interventions of meniscal and articular cartilage lesions with respect to postsurgical care. Conclusion the composite examination for specific meniscal or ligamentous injuries of the knee performed much better than specific maneuvers, suggesting that synthesis of a group of examination. The thessaly test is the most sensitive and specific clinical test to diagnose meniscal injury. The meniscus is the soft fibrous shock absorber in the knee.
Sports injury medicine department 9250 sw hall blvd. Meniscal injury is common, and the medial meniscus is more frequently injured. They may also occur from contact to the lateral or medial part of the knee while the lower extremity is planted. Because of this tear distribution, i am cautious in diagnosing a medial meniscal tear that does not involve the posterior horn. Your physiotherapist has diagnosed you with a degenerative meniscal tear. The prevalence of asymptomatic tears, which typically are horizontal tears, increases with age 1,2. Evaluating acutely injured patients for internal derangement. Five medial meniscus and 2 lateral meniscus tears were seen at arthroscopy. It is well established that meniscal damage predisposes the adjacent articular. Nov 21, 2016 because the clinical diagnosis accuracy is about 70%, and because there are other issues on the knee that can give you the same symptoms like the meniscal tear.
Pain and swelling are the most common signs of an injury to your. Tears can cause knee pain, swelling, limited range of motion, and catching, locking, and buckling of the knee joint. Meniscal tears among the most common of knee injuries. If an athlete suffers a meniscal root tear, the three options for treatment. James diagnosis and treatment of meniscal root tears 84 minerva ort opedica e traumat l gica june 2017 et al. To avoid errors in diagnosing meniscal tears, those interpreting mr. Mri versus ultrasound in diagnosis of meniscal tear in knee joint. When people talk about torn cartilage in the knee, they are usually referring to a torn meniscus. Meniscal injuries can occur in isolation or in association with collateral or cruciate ligament tears. A meniscal tear is the most common soft tissue injury affecting the knee.
With a sensitivity of 95% and a specificity of 81% for medial meniscal tears and sensitivity of 85% and a specificity of 93% for lateral meniscal tears 2,5, mri is the modality of choice when a meniscal tear is suspected, with sagittal images being the most sensitive 5. A meniscal tear occurs in 2 primary planes, vertical and horizontal. When interviewing a patient with a suspected meniscal tear, a detailed history and physical examination should be obtained. While there is some evidence that these symptoms can help in the diagnosis of symptomatic meniscal tear 7, nonetheless it. Meniscal root tears are often caused by chronic degenerative changes or acute trauma to the knee. A lateral meniscus tear was suspected in 27 knees and confirmed in 25. While there is some evidence that these symptoms can help in the diagnosis of symptomatic meniscal tear 7, nonetheless it remains difficult for clinicians to identify a meniscal tear as the primary source of a patients symptoms on the basis of history and physical examin. Accurate and timely diagnosis of a meniscal tear is critical for reducing morbidity and planning treatment. Injury of the knee joint meniscus is one of the most prevalent injuries in the human body.
The final diagnosis of the 62 meniscal lesions according to mri examination was meniscal degeneration in 44 71% lesions, and meniscal tear in 18 29% lesions table 3. In my recent experience, a definitive diagnosis of an intact or a torn meniscus can be made in 95% of knee mr examinations. The physician treating an athlete with a known or suspected meniscal tear needs to understand the structure and function of the meniscus and the factors involved in treating an athlete. Athletes, particularly those who play contact sports, are at risk for meniscus tears. This article outlines the aetiology, presentation, diagnosis both clinical and radiographic and management of these important injuries. In the remaining 5% of patients, it is not possible to be definitive but a diagnosis of a possible tear or a probable lateral posterior root tear or a differential diagnosis of meniscal fraying or tear should be given. As we age, this cartilage begins to lose elasticity and can easily be torn without any type of trauma. Behrens, md abstract meniscal injury is a common cause for presentation to the emergency department or primary care physicians office. A torn meniscus is the most common cause of mechanical symptoms in the knee. An mri may be used to assist in making the diagnosis. Often times these tears can be diagnosed by taking a thorough history and completing a physical. It is well established that meniscal damage predisposes the adjacent articular cartilage to increased axial and sheer stress, resulting in early degenerative osteoarthritis 1.
Because the clinical diagnosis accuracy is about 70%, and because there are other issues on the knee that can give you the same symptoms like the meniscal tear. A torn meniscus can lead to a feeling of your knee giving way, inability to move your knee normally or persistent knee pain. You might be more likely to develop osteoarthritis in the injured knee. Mr imagingbased diagnosis and classification of meniscal. The meniscus is a piece of cartilage that provides a cushion between your femur thighbone and tibia shinbone. In this article on knee pain in adults, the authors contend that the thessaly test is an accurate test for diagnosing meniscal injury. Mri scan considered most accurate and noninvasive method of diagnosis. Racgp meniscal tear presentation, diagnosis and management. The signs and symptoms of a meniscal tear may include a popping sensation when moving the knee, swelling or stiffness, pain especially when rotating your knee. Any information contained in this pdf file is automatically generated from digital. Tears are usually described by where they are located anatomically in the c shape and by their appearance for example, bucket handle tear, longitudinal, parrot beak, and transverse. Traditionally, sonography has had low utilization as a tool in the diagnosis of degenerative meniscal pathology.
Mri versus ultrasound in diagnosis of meniscal tear in. In addition, i discuss my experience with the causes of errors in the mr diagnosis of meniscal abnormalities and the nuances of meniscal abnormali ties that can mimic a meniscal tear. Meniscal injuries can be the result of a forceful, twisting event in a young athletes knee or it can insid. Magnetic resonance imaging mri of the knee largely has replaced arthrography as the imaging modality of choice for the menisci, as the accuracy has been shown to be greater than 90%. Diagnosing a meniscal tear clinically is a challenge as several different diagnostic tests exist and the positive ppv and negative predictive values npv of these tests depend on the. Meniscal tear presentation, diagnosis and management racgp. Diagnosis of the most common tear patterns seen at mr imaging will be described, including horizontal, longitudinal, radial, root. Apr 24, 2020 arthroscopy of the knee is the criterion standard for the diagnosis of a meniscal tear. A combination of historical features and examination findings will help alert physicians to the possibility of meniscal tear more than the results of any one test. Meniscal cartilage curves like the letter c at the. Rehabilitation guidelines for meniscal repair of root and.
1567 341 115 1609 633 1608 1333 722 905 1337 1118 455 785 1005 374 1245 1423 1115 708 1628 1017 544 1502 1576 1120 857 738 544 289 610 956 179 1293 766 603 1435 722 17 984 533 527