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Anatomy
Bone of the knee are the distal
femur, the proximal tibia, and the
patella
Menisci and Joint Capsule
Menisci provide shock absorption,
allow for increased congruency
between joint surfaces, enhance joint
stability, and aid in distribution of
synovial fluid.
Anterior cruciate Posterior cruciate
ligament ligament
Meniscal injury
The medial meniscus is more frequently torn than the lateral
meniscus because the medial meniscus is securely attached
around the entire periphery of the joint capsule, whereas the
lateral meniscus has a mobile area where it is not attached
Clinical Findings
The patient is usually a young person who sustains a
twisting injury to the knee on the sports field. Pain (usually on
the medial side) is often severe and further activity is avoided;
occasionally the knee is locked in partial flexion. Almost
invariably, swelling appears some hours later, or perhaps the
following day. With rest the initial symptoms subside, only to
recur periodically after trivial twists or strains. Sometimes the
knee gives way spontaneously and this is
again followed by pain and swelling.
most important physical examination findings in the
knee with a meniscus tear are joint line tenderness
and an effusion. Other specialized tests include the
McMurray, flexion McMurray, and Apley grind tests.
The McMurray test is performed with the patient lying
supine with the hip and knee flexed to approximately
90 degrees. While one hand holds the foot and twists
it from external to internal rotation, the other hand
holds the knee and applies compression (see Figure 4
12). A positive test is one that elicits a pop or click
that can be felt by the examiner when the torn
meniscus is trapped between the femoral condyle and
tibial plateau.
Mc Murray test
MRI is a reliable method of
confirming the clinical diagnosis, and
mayeven reveal tears that are
missed by arthroscopy.
Arthroscopy has the advantage that,
if a lesion is identified, it can be
treated at the same time.
Treatment