Meniscal Tears

Two distinct forms: acute rupture (athletes, contact sports) and degenerative tears (>50 yrs) — the latter are essentially part of osteoarthritis and should be managed conservatively. Medial tears are 3× more common than lateral, except with a concurrent ACL tear (lateral more likely).

• History:
  • acute: twisting force on a partially bent, weight-bearing knee
  • degenerative: appear with minor or no trauma
  • catching and locking; joint swelling (acute onset suggests a peripheral tear — these can cause haemarthrosis).
• Examination:
  • joint-line tenderness (~49% sensitivity)
  • reduced flexion and loss of the last 5–10° of extension
  • McMurray test; Thessaly test (twisting on a weight-bearing knee flexed 20°).
• Investigations:
  • X-ray should be normal (useful to assess for OA in older patients)
  • MRI — grade 1–2 signal changes are not significant; a grade III tear is; a parameniscal cyst indicates a tear.
• Management:
  • rest, NSAIDs and physiotherapy for degenerative tears and as initial treatment of acute tears
  • patients with preserved joint function, minimal pain and willingness to modify activity mostly recover without surgery
  • orthopaedic referral for consideration of arthroscopy in young patients with an acute grade III tear (or true locking).

Do not arthroscope degenerative tears: multiple RCTs (e.g. FIDELITY, sham-surgery controlled) show no benefit of arthroscopic partial meniscectomy over physiotherapy/sham in degenerative tears.