Abstract
Acute medial meniscal injury is the most commonly encountered cause of significant knee pain secondary to trauma that is seen in clinical practice. The incidence of acute tear is approximately 60 cases per 100,000 individuals. Acute tears often result from sudden twisting or squatting with weight bearing The male predominance is more than 2:1. Medial meniscal tear is a disease of the third and fourth decades in men and the second decade in girls and women. In older patients, the incidence of degenerative medial meniscal tears approaches 60%, although not all these tears cause significant pain and functional disability for the patient.
A medial meniscal tear is characterized by pain at the medial aspect of the knee joint line. The medial meniscus is a triangular structure on cross section that is approximately 3.5 cm in length from anterior to posterior. This structure is wider posteriorly and is attached to the tibia by the coronary ligaments, which are also susceptible to trauma, as are the fibrous connections from the joint capsule and the medial collateral ligament.
Keywords
medical meniscus, knee pain, medial meniscal tear, bucket handle tear medial meniscus, knee trauma, magnetic resonance imaging, diagnostic sonography, ultrasound guided injection
ICD-10 CODE M23.219
Keywords
medical meniscus, knee pain, medial meniscal tear, bucket handle tear medial meniscus, knee trauma, magnetic resonance imaging, diagnostic sonography, ultrasound guided injection
ICD-10 CODE M23.219
The Clinical Syndrome
The meniscus is a unique anatomic structure that fulfills various functions to allow ambulation in the upright position ( Box 108.1 ). The meniscus is susceptible to both acute injury from trauma and degenerative tears, which are more chronic. Tears of the medial meniscus are classified by their orientation and shape ( Box 108.2 ).
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Load bearing
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Conversion of compressive forces to tensile forces
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Load distribution
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Stabilization of the joint
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Lubrication of the joint
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Proprioception
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Longitudinal
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Bucket handle
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Parrot beak–shaped oblique
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Horizontal
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Radial
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Complex combination
Acute medial meniscal injury is the most commonly encountered cause of significant knee pain secondary to trauma that is seen in clinical practice. The incidence of acute tear is approximately 60 cases per 100,000 individuals. Acute tears often result from sudden twisting or squatting with weight bearing ( Fig. 108.1 ). The male predominance is more than 2 : 1. Medial meniscal tear is a disease of the third and fourth decades in men and the second decade in girls and women. In older patients, the incidence of degenerative medial meniscal tears approaches 60%, although not all these tears cause significant pain and functional disability for the patient.
A medial meniscal tear is characterized by pain at the medial aspect of the knee joint line. The medial meniscus is a triangular structure on cross section that is approximately 3.5 cm in length from anterior to posterior ( Fig. 108.2 ). This structure is wider posteriorly and is attached to the tibia by the coronary ligaments, which are also susceptible to trauma, as are the fibrous connections from the joint capsule and the medial collateral ligament.
Signs and Symptoms
Patients with medial meniscal tear present with pain over the medial joint space and increased pain on the McMurray, squat, and Apley grinding tests ( Fig. 108.3 ). Activity, especially flexion and external rotation of the knee, worsens the pain, whereas rest and heat provide some relief. The pain is constant and is characterized as aching; it may interfere with sleep. Patients with injury to the medial meniscus may complain of locking or popping with flexion of the affected knee. An effusion is often present and can be quite pronounced in some patients. Coexistent bursitis, tendinitis, arthritis, or other internal derangement of the knee may confuse the clinical picture after trauma to the knee joint.
