T&O: Meniscal Tears

Question 1

Outline the physiology of the meniscus

Answer 1

C-shaped fibrocartilage found in the knee joint

Menisci rest on the tibial plateau

Shock-absorbers of the knee joint

Increase articulating surface area.

Medial meniscus is more circular than the lateral and is attached to the medial collateral ligament

Question 2

Outline the types of meniscal tears

Answer 2

Vertical

Longitudinal (Bucket-Handle) = most common

Transverse (Parrot-beak)

Degenerative

Question 3

Outline the aetiology of a meniscal tear

Answer 3

Trauma = twisted their knee whilst it is flexed and weight-bearing

Degenerative disease

Question 4

Outline the symptoms of meniscal tears

Answer 4

‘tearing’ sensation

Intense sudden onset pain

Swelling (6-12hours)

Locked in flexion = where the tear results in a free body, typically bucket-handled

Tenderness

Joint effusion

Limited knee flexion

Question 5

How would you investigate a meniscal tear?

Answer 5

McMurray’s Test = +ve produces pain/popping, externally rotates tibia by ankle, valgus force, extends knee

Apley’s Grind Test = +ve produces pain, pt prone, knee flexed 90 degrees, examiners knee on posterior thigh, tibia compressed onto the knee joint while being externally rotated

X-ray = exclude fracture

MRI = gold standard

Question 6

How would you manage a meniscal tear?

Answer 6

Rest, ice, compression, elevation (RICE)

Outer third tear = surgery to suture back together

Inner third = surgery to repair or trim

Question 7

What are the complications of Meniscal Tears?

Answer 7

Osteoarthritis.

Knee arthroscopy carries a risk of deep vein thrombosis and damage to local structures, such as the saphenous nerve and vein, the peroneal nerve, and the popliteal vessels.