lesions of the menisci
DESCRIPTION
Briefly presented on meniscal tear, the tests done, and treatmentTRANSCRIPT
LESIONS OF THE MENISCI
ROSSHINI JAGATHESWARAN
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Tears of the meniscus
More likely to tear along its length
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Mechanism of InjuryRotational grinding force (knee flexed and twisted while taking weight – footballers)Common in medial meniscus
ClassificationVertical/LongitudinalHorizontal Radial
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Vertical/longitudinal tears
Most commonAnterior horn tearPosterior horn tearBucket-handle tear
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Horizontal tearsDegenerativeRepetitive minor traumaMay progress to flap tear
Radial tearsrun from inner edge of the meniscus to the outer bodyParrot beak tear -incomplete
Flap tear
Parrot-beak tear
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Clinical FeaturesUsually a young personTwisting injurySports injury
SymptomsPainAvoids further activityLocking of the knee in partial flexion (DIAGNOSTIC)SwellingRecur periodically after trivial twists and strains
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SignsJoint may be held slightly flexedEffusion of the knee – patellar tap positiveWasting of quadricepsTenderness localised to joint lineFull flexion but limited extensionMcMurray’s test positiveApley’s grinding test positiveThessaly test positive
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Differences between hemarthrosis and effusion
Hemarthrosis Effusion
Swelling seen immediately after injury
Swelling presents later after injury
Cruciate or peripheral meniscal lesion in the absence of a fracture
Tear of the inner meniscus or synovial irritation
Patella tap positive
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McMurray’s Test–Lateral Meniscus
Patient supineKnee completely flexedGrasp the ankle (lower tibia) firmly with one hand and the knee (lateral joint line) with the otherFoot internally rotatedExtend the knee with a varus force to knee As femur passes over the torn meniscus : pain / clicking sound
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McMurray’s Test – Medial Meniscus
Patient supineKnee completely flexedGrasp the ankle (lower tibia) firmly with one hand and the knee (medial joint line) with the otherFoot externally rotatedExtend the knee with a valgus force to knee As femur passes over the torn meniscus : pain / clicking sound
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Apley’s grinding test
Patient proneKnee flexed to 90 degreesKnee rotatedCompression force appliedPain indicates torn meniscus
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Thessaly Test
Patient stands flat footed on one leg Examiner hold his/her handsFlex the affected knee to 20 degrees Ask patient to twist body side to side thricePain at medial or lateral joint lines, locking – meniscal tear
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InvestigationsPlain X-raysMagnetic Resonance Imaging (MRI)Arthroscopy
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MRI Findings
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• Arthroscopy
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Differential Diagnosis
Loose bodiesRecurrent dislocation of patellaFracture of tibial spinePartial tear of medial collateral ligamentTorn anterior cruciate ligament
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Tears of the meniscus
TreatmentDealing with the locked knee•Gentle passive flexion and rotationConservative•After an cute episode, joint held straight in plaster backslab for 3-4 weeks•Crutches and quadriceps exercise•RICE protocolOperative•Indicated if joint cannot be unlocked and symptoms are recurrent6/3/2014 20
THANK YOU
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