Meniscal injury of the knee
- Dennis A Cardone, DO
Dennis A Cardone, DO
- Associate Professor of Orthopedic Surgery
- Chief, Division of Primary Care Sports Medicine
- NYU Langone Medical Center
- Bret C Jacobs, DO, MA
Bret C Jacobs, DO, MA
- Clinical Assistant Professor of Orthopedic Surgery
- Division of Primary Care Sports Medicine
- NYU Langone Medical Center
- Section Editor
- Karl B Fields, MD
Karl B Fields, MD
- Editor-in-Chief — Primary Care Sports Medicine (Adolescents and Adults)
- Section Editor — Biomechanics, Rehabilitation, and Recovery; Sports-Related Injuries; Symptom Assessment and Physical Examination
- Professor of Family Medicine and Sports Medicine
- University of North Carolina at Chapel Hill
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Emergency Medicine (Adult and Pediatric)
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
Meniscal injuries of the knee are common. Acute meniscal tears occur most often from twisting injuries; chronic degenerative tears occur in older patients and can occur with minimal twisting or stress. Tears are classified as partial or complex; anterior, lateral, or posterior; traumatic or degenerative; and horizontal, vertical, radial, "parrot-beak," or "bucket handle" .
Left untreated, large complex tears can impair smooth motion of the knee, cause joint effusions, and may lead to premature osteoarthritis. Meniscal injuries can occur in isolation or in association with collateral or cruciate ligament tears. (See "Medial collateral ligament injury of the knee" and "Anterior cruciate ligament injury".)
The diagnosis and treatment of meniscal injuries will be reviewed here. Undifferentiated knee pain in the adult, physical examination of the knee, and other specific knee injuries are discussed separately. (See "Approach to the adult with unspecified knee pain".)
The two menisci contained within the knee joint are crescent-shaped pads of fibrocartilage located between the femoral condyles and the tibial plateaus (figure 1 and figure 2) . They aid in dissipating loading forces placed on the knee, stabilizing the knee during rotation, and lubricating the knee joint.
In cross section, the medial and lateral menisci are wedge-shaped with the thicker portion along the joint periphery, where they attach to the joint capsule of the knee (sometimes referred to as root attachments). The medial meniscus is firmly attached to the medial collateral ligament; the lateral meniscus is not rigidly attached to the lateral collateral ligament and therefore more mobile. This may contribute to the lower injury rate of the lateral meniscus.
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- MECHANISM AND PRESENTATION
- PHYSICAL EXAMINATION
- General knee function
- Provocative testing
- Detection of an effusion
- Plain radiographs
- Magnetic resonance imaging
- DIFFERENTIAL DIAGNOSIS
- Initial management
- Approach to treatment and orthopedic referral
- Persistent symptoms
- - Knee "locking"
- Arthroscopic or open surgery
- Chronic degenerative meniscal injury
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS