Meniscus Injury

Almas Prawoto

Meniscus Tears
Meniscus tears are
among the most
common knee injuries.
Occur from force
between femur and
tibia.
Incidence: 6/1000
population
2.5 to 4 times male
predominance
Age of injury peak at
20-29 years

Pathophysiology
Younger patients
bucket handle tears
a twisting force on a
flexed knee results in
a vertical or oblique
tear in the posterior
horn.
Older patients
degeneration and
tend to be horizontal
tears.

History
Often young patients who have
suffered a twisting injury to the knee.
Severe pain, swelling and possibly
clicking
Difficulty in knee bending and weight
bearing
Stiffness impossible to extend the
knee

Physical Examination
McMurray test
Apley tests: grinding test:
patient lies prone. Knee is
flexed 90 degrees.
Examiner applies pressure
to the foot and rotates the
tibia internal and externally.
Thessaly Test: Patient
stands flat footed with their
knee flexed 20 degrees.
Patient rotates internally
and externally three times.

Diagnosis
MRI is the gold standard method of
diagnosis
X-ray only helpful to remove
differential diagnosis

Treatmenet: conservative measures

Immediate conservative measures
include the RICE regimen:
R: rest (with crutches)
I: ice
C: compression bandaging
E: Elevation of the affected limb to
minimize acute swelling and inflammation

NSAIDs for 8-12 weeks

Physiotherapy

Treatment
Conservative treatments successful in:
patients with no loss of joint function
Suffer minimal pain and swelling
Willing to reduce their activity

46% of patients with degenerative tears

did not have surgery, after 4 weeks of
non operative treatments and their
functional improvement matched those
in the operative group.

Surgical treatment
Good for younger patients with tears
in the vascularized outer third of the
mensicus (red red zone).
White-white zone tears are rarely
repaired resected (meniscectomy).
This may cause long term
osteoarthritsi.