Meniscus

Question 1

ESSENCE

Answer 1

Damage to the meniscus, which is the cartilage around knee joint

Question 2

ANATOMY

How many meniscus and what function

Answer 2

A lateral and medial, function is to act as shock absorber and help stabilise joint

Question 3

ANATOMY

What is attached to patella, and what attached it to the tibia

Answer 3

Quadriceps tendon attached to patella

Patella attached to tibia by patellar ligament

Question 4

ANATOMY

What are the 4 ligaments of knee

Answer 4

• Anterior cruciate ligament
• Posterior cruciate ligament
• Lateral collateral ligament
• Medial collateral ligament

Question 5

AETIOLOGY

Most common cause

Answer 5

• Sports injuries in young
• During normal activities in elderly

Question 6

AETIOLOGY

Risk factors

Answer 6

• Acute trauma (twisting injury)
• Knee joint arthritis
• Knee instability
• History of anterior cruciate injury
• Malalignment of knee joint
• Weather conditions/rough ground

Question 7

CLINICAL FEATURES

Presentation

Answer 7

• Pop sound or sensation at initial injury
• Pain - can be referred to hip or lower back
• Swelling
• Stiffness
• Restricted range of motion
• Locking of knee
• Instability of knee

Question 8

CLINICAL FEATURES

Examination findings

Answer 8

• Localised tenderness on joint line
• Swelling
• Restricted range of motion

Question 9

2 special tests

Answer 9

• They are generally not used or recommended in clinical practice as can cause pain or worsen injury
  
  • McMurrays test
  • Apley grind test

Question 10

What is McMurrays test

Answer 10

• Patient lies supine and examiner takes the leg and flexes knee
• While internally rotating tibia and applying varus pressure to knee, knee is carefully extended, pain or restriction indicates lateral meniscal damage
• Repeating the flexed to extended movement with external rotation and valgus pressure, pain indicates medial meniscal damage

Question 11

What is Apley grind test

Answer 11

• Patient lies supine and flexes knee to 90 with thight flat on couch
• Downwards pressure applied through leg into knee and tibia is internally and externally rotated
• Pain indicates positive result, suggesting meniscal damage, it is localised to area of damage (lateral or medial meniscus)

Question 12

What are key general differentials for knee injury

Answer 12

Bone fractures

Question 13

What criteria is used to determine if x-ray required after acute knee injury

Answer 13

Ottawa knee rules

Question 14

Describe Ottawa knee rules

Answer 14

• Requires x-ray if any of following present
  
  • Age > 55
  • Patella tenderness (no tenderness elsewhere)
  • Fibular head tenderness
  • Cannot flex knee to 90
  • Cannot weight bear

Question 15

INVESTIGATIONS

First choice

Answer 15

• MRI scan - first line imaging for establishing diagnosis
• Arthroscopy - visualise meniscus, gold standard investigation for diagnosing meniscal tear

Question 16

MANAGEMENT

General principles

Answer 16

• Conservative management
• Analgesia - NSAIDs
• Physiotherapy
• Surgery may be required

Question 17

MANAGEMENT

Conservative

Answer 17

• Remember RICE
  
  • Rest
  • Ice
  • Compression
  • Elevation

Question 18

MANAGEMENT

Surgery

Answer 18

• Arthroscopy (keyhole surgery)
  
  • Repair if possible
  • Resection of affected porstion (often results in osteoarthritis)