Meniscal Tears—Examination and Tests

Meniscal Tears

The meniscus is an important cushion which lies between the femoral condyles and the tibial plateau. When the meniscus is injured, there is usually a history of a twisting injury, and the patient will have pain on either the medial or lateral side of the knee. The patient may be experiencing some swelling of the knee as well as mechanical symptoms such as clicking, locking, and catching.

During the exam there may be some effusion. However, the most important finding will be the presence of tenderness along the medial or lateral joint line, which the doctor should suspect is occurring due to a meniscal tear. Pain at the knee may possibly come from other sources such as arthritis, bursitis, or a ligament injury. The most important test is the presence of tenderness at the joint line. The range of motion is usually normal.

Provocative Tests

The provocative tests all have the same idea. One of the tests is done with the patient standing, another with the patient lying in the prone position, and the last test is done with the patient lying in the supine position.

The goal of the test is to trap the meniscus between the tibia and the femur with rotation and twisting. These tests allow medical professionals to evaluate the lateral and medial menisci. When performing these provocative tests, if there is a presence of “clicking” or “popping” with pain when doing these maneuvers, then this is suggestive of a meniscal tear.

The most popular test is the McMurray’s Test. During this exam, a painful click may be obtained as the knee is brought from flexion to extension in either internal or external rotation.

Another type of testing is known as the Apley Compression Test. When performing this exam, the patient should be lying in the prone position with the knee bent to 90°. This will allow the weight of the tibia and foot to press down onto the joint. The physician will place the fingers over the joint line and rotate the tibia with compression force. If during this procedure the patient experiences pain with either a click or pop, then the test is positive for a meniscal tear.

If you rotate the tibia with distractive force which causes the patient pain, then this means that there is a ligament injury and not a meniscal tear.

During the Thessaly Test, the patient will stand on the affected limb and bend the knee about 20°.

The patient should then twist their body with the knee in either internal or external rotation aboue three times. A positive test result is determined with the patient experiences either a click or pop sensation with pain in the knee.

These tests are not specific for meniscal pathology. An MRI is the procedure of choice to confirm a meniscal tear. If you have a bucket handle tear that will block full extension of the knee, then you will probably need to get an MRI early.