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meniscal tear

Etiology: - acute twisting knee injury - degenerative joint disease may contribute Clinical manifestations: - pain, locking, catching, grinding - usually able to bear weight immediately - effusions, if any, generally small [16] - McMurray test often positive Radiology: - indications for MRI - inability to bear weight after injury - joint instability - significant locking of the joint - evidence of concomitant ligamentous injury on examination - persistent knee pain & swelling > 2 weeks on conservative management - middle-aged patients with knee pain & suspected meniscal tear may benefit from MRI in simple cases [17] - 8% with findings that should change management [17] Differential diagnosis: - mechanical symptoms including knee catching/locking, grinding/clicking/popping, & knee pain with pivoting correlate better with cartilage damage than with meniscal tears in patients who undergo arthroscopic surgery [13] Management: - a trial of non-operative management should be 1st line - physical therapy may be a reasonable alternative to early surgery for adults with nonobstructive meniscal tears [8] - as effective as surgery for treatment of meniscal tears [12,15] - surgical removal of meniscus (meniscectomy) - arthroscopic partial meniscectomy or meniscal debridement no better than exercise programs, steroid injections, or sham surgery in patients with degenerative medial meniscus tear & mild or no osteoarthritis [1,2,4] - arthroscopic partial meniscectomy may be no better than exercise for traumatic meniscal tears [5] or degenerative meniscal tears [6,7] - early meniscal surgery is not superior to exercise & education with the option of later surgery among young, active adults [14] - meniscal_transplantation

Related

meniscectomy trauma/exercise/surgery & osteoarthritis

General

meniscal injury

References

  1. Sihvonen R et al Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear. N Engl J Med 2013; 369:2515-2524 PMID: 24369076 http://www.nejm.org/doi/full/10.1056/NEJMoa1305189
  2. Khan M et al Arthroscopic surgery for degenerative tears of the meniscus: a systematic review and meta-analysis. CMAJ August 25, 2014 First published August 25, 2014 PMID: 25157057 http://www.cmaj.ca/content/early/2014/08/25/cmaj.140433
  3. WebMD: Meniscectomy for a Meniscus Tear http://www.webmd.com/a-to-z-guides/meniscectomy-for-a-meniscus-tear
  4. Kise NJ et al Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up. BMJ 2016;354:i3740 PMID: 27440192 http://www.bmj.com/content/354/bmj.i3740 - Jarvinen TLN, Guyatt GH Arthroscopic surgery for knee pain. BMJ 2016;354:i3934 PMID: 27439983 http://www.bmj.com/content/354/bmj.i3934
  5. Thorlund JB et al. Patient reported outcomes in patients undergoing arthroscopic partial meniscectomy for traumatic or degenerative meniscal tears: Comparative prospective cohort study. BMJ 2017 Feb 2; 356:j356. PMID: 28153861 Free full text http://www.bmj.com/content/356/bmj.j356
  6. Siemieniuk RAC, Harris IA, Agoritsas T et al Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline. BMJ 2017;357:j1982 PMID: 28490431 Free PMC Article http://www.bmj.com/content/357/bmj.j1982
  7. Sihvonen R, Paavola M, Malmivaara A et al Arthroscopic partial meniscectomy versus placebo surgery for a degenerative meniscus tear: a 2-year follow-up of the randomised controlled trial Ann Rheum Dis. 2018 Feb;77(2):188-195. Epub 2017 May 18. PMID: 28522452 Free Article
  8. van de Graaf VA, Noorduyn JCA, Willigenburg NW et al Effect of Early Surgery vs Physical Therapy on Knee Function Among Patients With Nonobstructive Meniscal Tears. The ESCAPE Randomized Clinical Trial. JAMA. 2018;320(13):1328-1337. https://jamanetwork.com/journals/jama/fullarticle/2705186 - Jazrawi L, Gold HT, Zuckerman JD Physical Therapy or Arthroscopic Surgery for Treatment of Meniscal Tears. Is Noninferiority Enough? JAMA. 2018;320(13):1326-1327. https://jamanetwork.com/journals/jama/fullarticle/2705168
  9. Solomon DH, Simel DL, Bates DW, Katz JN, Schaffer JL. The rational clinical examination. Does this patient have a torn meniscus or ligament of the knee? Value of the physical examination. JAMA. 2001 Oct 3;286(13):1610-20. Review. PMID: 11585485
  10. Scholten RJ, Deville WL, Opstelten W et al The accuracy of physical diagnostic tests for assessing meniscal lesions of the knee: a meta-analysis. J Fam Pract. 2001 Nov;50(11):938-44. PMID: 11711009
  11. Tuite MJ, Daffner RH, Weissman BN et al ACR appropriateness criteria acute trauma to the knee. J Am Coll Radiol. 2012 Feb;9(2):96-103. PMID: 22305695
  12. Katz JN, Shrestha S, Losina E et al Five-Year Outcome of Operative and Nonoperative Management of Meniscal Tear in Persons Older Than Forty-Five Years. Arthritis Rheumatol. 2020 Feb;72(2):273-281 PMID: 31429198
  13. Farina EM, Lowenstein NA, Chang Y et al. Meniscal and mechanical symptoms are associated with cartilage damage, not meniscal pathology. J Bone Joint Surg Am 2021 Mar 3; 103:381. PMID: 33448713 https://journals.lww.com/jbjsjournal/Abstract/2021/03030/Meniscal_and_Mechanical_Symptoms_Are_Associated.3.aspx
  14. Skou ST, Holmich P, Lind M et al. Early surgery or exercise and education for meniscal tears in young adults. NEJM Evidence 2022 Feb; 1:EVIDoa2100038. PMID: 38319181 https://evidence.nejm.org/doi/10.1056/EVIDoa2100038
  15. Noorduyn JCA et al. Effect of physical therapy vs arthroscopic partial meniscectomy in people with degenerative meniscal tears: Five-year follow-up of the ESCAPE randomized clinical trial. JAMA Netw Open 2022 Jul 8; 5:e2220394. PMID: 35802374 Clinical Trial. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2794027
  16. Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  17. Waddell LM, Opare-Addo MB, Shah N et al Prevalence of Clinically Relevant Findings on MRI in Middle-Aged Adults with Knee Pain and Suspected Meniscal Tear: A Follow-Up. Arthritis Care Res (Hoboken). 2024 Sep 29. PMID: 39344165 https://acrjournals.onlinelibrary.wiley.com/doi/abs/10.1002/acr.25444