Best test for meniscal tear
How will a meniscal tear present, and is there a single best test for diagnosis?
The meniscus functions as a cushion between the femur and tibia on the medial and lateral sides of the knee. It is well suited to compression but tears when subjected to shear stress with a turning or twisting motion. The nutrition of the inner two-thirds of the meniscus is limited and predisposes the torn tissue to not heal once torn, a factor reflected by the typical chronic recurring history of symptoms. The torn tissue may create a mechanical block to the free motion of the knee, which will symptomatically manifest as clicking, popping, and locking, and is associated with pain and swelling at the joint line. These symptoms correlate, but often unreliably, to an audible/palpable pop with flexion/extension of the knee with the patient supine (McMurray’s test) and prone (Apley’s test) on physical examination. Joint line tenderness is one of the best clinical signs of a meniscal tear, but all of these tests should be combined with the history as the presentation of a meniscal tear can be confused with patellofemoral pathology, particularly in the absence of a single precipitating event. MRI or arthroscopy reliably confirms diagnosis, and the problem is most efficiently remedied by arthroscopic repair or partial meniscectomy in an athlete. Chronic degenerative meniscal tears can oftentimes be treated with physical therapy alone.
