Meniscal Injuries

Normal Anatomy

• Wedge shaped Fibrocartilage

• Lateral meniscus more mobile than medial meniscus

• Provide shock absorption in weight bearing, stabilise joint, prevent hyperextension

• Peripherally good blood supply, centrally poor blood supply

Mechanism of Injury

• Weight bearing twisting • Hyperflexion• Popping or tearing

sensation at time of injury

• Degenerative overuse

Classification

Classification

Associated Pathologies

• ACL injury• MCL / LCL injury• ‘Unhappy triad’

Subjective

• History of twisting injury with foot anchored• Forced hyperflexion• Tearing sensation or an audible pop• Small tears may become painful / swell over

following 6 -24 hours• Locking – associated with larger tears

Objective

• Joint line tenderness• Joint effusion• Crepitus• Pain on flexion• Loss of flexion (>10o) • Pain on extension• Loss of extension (>5o)

Special Tests

• McMurray Test• Apley’s Test• “Bounce Home” Test• Thessaly• Ege’s• Axial loaded pivot shift

Clinical Prediction Rule

1. History of catching or locking

2. Joint Line Tenderness3. Pain with forced

hyperextension (modified bounce home test)

4. Pain with maximal passive knee flexion

5. Pain or audible click with McMurrays

• 3/5 = 76.7% Positive Predictive Value (PPV)

• 4/5 = 81.8% PPV• 5/5 = 92.3% PPV

Further Investigation

• MRI• Diagnostic Arthroscopy

Management

Non-Surgical• Symptoms develop over

24-48 hours• Minimal injury• Able to weight bear• Minimal swelling• Full ROM (pain only at

end ranges)• Pain only

Surgical• Severe twisting injury• Gross loss ROM• Positive McMurray

(with clunk)• Associated ACL tear• Little improvement

following 3 weeks of conservative treatment

Conservative - Management– Restore Normal Mobility

• Decrease swelling and inflammation around the joint– Soft tissue release– Ice– NSAID’s

• Normalise soft tissue– Frictions to joint line including coronary ligament– Soft tissue release to surrounding soft tissue

• Restore normal joint mechanics– Joint mobilisations if tolerable– Do not mobilise into flexion or extension if springy block is present due to meniscal tearing

– Restore Stability• Motor Control and Strength

– Inner Range Quads– Glutes

• Proprioceptive Training• Return to Sport/Activity Specific Exercises

Surgical - Management

• Meniscal resection• Partial meniscectomy• Meniscal repair

• Tears in the outer third of the meniscus can heal as there is blood supply to this area