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Key Features

  • Most meniscus injuries occur with acute injuries or repeated microtrauma, such as squatting or twisting

  • Joint line pain and pain with deep squatting are the most sensitive signs

  • Difficulty with knee extension suggests an internal derangement that should be evaluated urgently with MRI

Clinical Findings

  • Injuries to a meniscus can lead to pain, clicking, and locking sensation

  • Patient may have an antalgic (painful) gait and difficulty with squatting

  • Effusion or joint line tenderness may be present

  • Swelling usually occurs during the first 24 hours after meniscus injury

  • Meniscus tears rarely lead to the immediate swelling that is commonly seen with fractures and ligament tears

Diagnosis

  • The McMurray test, the modified McMurray test, and the Thessaly test can be performed to confirm the diagnosis (Table 41–7)

  • Most symptomatic meniscus tears cause pain with deep squatting and when waddling (performing a "duck walk")

  • Radiographs

    • Usually normal

    • May show joint space narrowing, early osteoarthritis changes, or loose bodies

  • MRI

    • Best diagnostic tool for meniscal injuries (93% sensitivity and 95% specificity)

    • High signal through the meniscus (bright on T2 images) represents a meniscal tear

Table 41–7.Knee examination.

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