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
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
The McMurray test, the modified McMurray test, and the Thessaly test can be performed to confirm the diagnosis (Table 41–6)
Most symptomatic meniscus tears cause pain with deep squatting and when waddling (performing a "duck walk")
Table 41–6.Knee examination. ||Download (.pdf) Table 41–6. Knee examination.
|Examine for the alignment of the lower extremities (varus, valgus, knee recurvatum), ankle eversion and foot pronation, gait, “SEADS” (swelling, erythema, atrophy, deformity, surgical scars).
|Include important landmarks: patellofemoral joint, medial and lateral joint lines (especially posterior aspects), pes anserine bursa, distal iliotibial band and Gerdy tubercle (iliotibial band insertion).
Range of motion testing
|Check range of motion actively (patient performs) and passively (clinician performs), especially with flexion and extension of the knee normally 0–10 degrees of extension and 120–150 degrees of flexion.
|Knee strength testing
|Test resisted knee extension and knee flexion strength manually.
|Ligament Stress Testing
Performed with the patient lying supine and the knee flexed to 20–30 degrees. The examiner grasps the distal femur from the lateral side, and the proximal tibia with the other hand on the medial side. With the knee in neutral position, stabilize the femur, and pull the tibia anteriorly using a similar force to lifting a 10- to 15-pound weight.
Positive test: Excessive anterior translation of the tibia compared with the other side indicates injury to the anterior cruciate ligament.
Performed with the patient lying supine and the knee flexed to 90 degrees. The clinician stabilizes the patient’s foot by sitting on it and grasps the proximal tibia with both hands around the calf and pulls anteriorly.
Positive test: There is anterior cruciate ligament laxity compared with the unaffected side.
Used to determine the amount of rotational laxity of the knee. The ...