Meniscal tear
Meniscal tear is diagnosed clinically from a twisting-injury history with joint-line tenderness and a positive McMurray or Thessaly test, and management is conservative first for both acute and degenerative tears, with surgery reserved for persistent mechanical symptoms.
- Topic reviewThe full article, organized the way the exam asks it.
- ABIM-format MCQsVignettes with an explanation for every wrong answer.
- Key factsThe numbers and thresholds worth memorizing, up front.
- AI tutorMedBrain answers the question you're stuck on.
What this article covers
- Overview
The menisci are C-shaped fibrocartilage wedges that deepen the tibial plateau, distribute axial load, and provide secondary stabilization to the knee.
- Epidemiology
Two distinct populations: acute traumatic tears cluster in young, active patients performing pivoting or twisting sports; degenerative tears cluster in patients over age 40 and are frequently identified incidentally on knee imaging.
- Risk factors
Sports involving pivoting, cutting, or deep-flexion twisting: soccer, basketball, and skiing combine axial load with rotation on a planted foot.
- Pathophysiology
Acute traumatic tear: a sudden change in direction or speed while the knee is flexed and the foot is planted traps the meniscus between the femoral condyle and tibial plateau, generating torsional…
- Clinical features
Acute twisting knee injury with a sudden change in speed or direction, often with a felt tearing or popping sensation: the classic history for a traumatic tear; in older patients, a similar complex…
- Differential diagnosis
Anterior cruciate ligament tear: a positive Lachman test, rapid hemarthrosis within 2 to 3 hours, and inability to bear weight immediately distinguish it from the delayed, smaller effusion and…
- Diagnosis
Meniscal tear is a clinical diagnosis established by a twisting-injury history (or minimal trauma in an older patient), joint-line tenderness, and a positive Thessaly or McMurray test; imaging is not required in a typical presentation.
- Management
First, initiate conservative therapy for both acute and chronic (degenerative) meniscal tears, regardless of age: rest, ice, and a structured program of quadriceps and hamstring strengthening.
- Complications
Accelerated osteoarthritis: loss of meniscal tissue, whether from injury or partial meniscectomy, reduces load distribution across the tibiofemoral joint and accelerates cartilage degeneration.
- Prognosis
Most acute and degenerative meniscal tears improve with conservative management alone, particularly with adequate quadriceps and hamstring strengthening.
- Prevention
Neuromuscular and proprioceptive training programs for athletes in pivoting and cutting sports (soccer, basketball, skiing) reduce twisting-injury incidence.
Read the whole article
Subscribing to Internal Medicine opens every article, the full question bank and MedBrain, on the web, iPhone and Android.
Related articles
- Anterior cruciate ligament tear
Anterior cruciate ligament tear is a noncontact pivoting knee injury diagnosed clinically with the Lachman test and confirmed on MRI, and the central decision is surgical reconstruction versus supervised rehabilitation based on age, activity level, and knee instability.
- Osteoarthritis
Osteoarthritis is a chronic progressive joint disorder of cartilage and subchondral bone degradation with low-grade synovitis, diagnosed clinically from age, activity-related pain, and exam findings, and managed with exercise, weight loss, topical or oral NSAIDs, and joint replacement for refractory disease.
- Patellofemoral pain syndrome
Patellofemoral pain syndrome is a clinical diagnosis of disordered patellar tracking causing poorly localized anterior knee pain with stairs, squatting, and prolonged sitting, requiring no imaging, and its only proven long-term treatment is physical therapy that strengthens the quadriceps, hamstrings, and gluteal muscles.
- Popliteal Baker cyst
A popliteal (Baker) cyst is a synovial fluid-filled outpouching of the gastrocnemius-semimembranosus bursa driven by intra-articular knee pressure from osteoarthritis, inflammatory arthritis, or meniscal injury, and is managed by aspirating and injecting the knee joint rather than the cyst itself, since a ruptured cyst can masquerade as deep venous thrombosis.
- Iliotibial band syndrome
Iliotibial band syndrome is an overuse friction injury of runners and cyclists causing lateral knee and distal thigh pain, diagnosed at the bedside with a positive Noble compression test and treated first with activity modification, ice, and hip abductor strengthening rather than imaging or surgery.
- Patellar dislocation
Patellar dislocation is an acute lateral displacement of the patella out of the femoral trochlear groove, usually from a twisting non-contact pivot or a direct blow, presenting with a hemarthrosis and a positive apprehension test, and confirmed by plain radiograph with MRI reserved to assess the medial patellofemoral ligament and cartilage before deciding on bracing versus surgical stabilization.
- Rheumatoid arthritis
Rheumatoid arthritis is a chronic systemic autoimmune disease causing symmetric small-joint polyarthritis of the hands and feet that spares the distal interphalangeal joints, with morning stiffness over an hour. Diagnosis combines the ACR/EULAR classification criteria with rheumatoid factor, anti-CCP antibody, and radiographs. Treat-to-target management anchors on methotrexate, escalating to a biologic or targeted synthetic disease-modifying antirheumatic drug when remission is not reached.