History taking and clinical examination in musculoskeletal disease
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
The presence of palpable joint line tenderness is the most sensitive clinical examination test for a meniscal tear. Flex the knee to 90° and palpate the joint line using your thumb and index finger. Note any areas of tenderness. Tests for meniscal damage are not very reliable but, combined with a history of mechanical symptoms, locking, catching and pain, may be helpful. With posterior medial meniscal tears patients suffer pain on high flexion or squatting. The well- known test for meniscal tears is McMurray's test. The patient lies supine with their knee flexed to 45° and hip flexed to 45°. The examiner braces the lower leg: one hand holds the ankle; the other hand holds the knee. For assessment of the medial meniscus, palpate the medial joint line with knee flexed. A ‘click' may be felt suggesting meniscus relocation. A valgus stress is applied to the flexed knee. Externally rotate the leg (toes point outward), and slowly extend the knee while it is still in valgus.
Examination of Knee Joint in a Child
Nirmal Raj Gopinathan in Clinical Orthopedic Examination of a Child, 2021
The test is performed with the patient supine (Figure 10.21). The examiner holds the patient’s heel with one hand and stabilizes the knee with the other. The joint lines are palpated with the examiner’s thumb and fingers. The patient’s knee is then flexed maximally. To test the lateral meniscus, the tibia is rotated internally, and the knee is extended from maximal flexion to about 90° and vice versa. The examination of the whole of the posterior part of the menisci, beginning from the middle to their posterior attachment, is permitted by this gradual maneuver of flexion and extension. Added compression to the lateral/medial meniscus can be produced by placing valgus/varus stress, respectively, across the joint line while the knee is being extended. The occurrence of a click accompanied by a previously experienced sensation of pain as occurred when the knee gave way is indicative of a meniscal tear.
The Knee
Louis Solomon, David Warwick, Selvadurai Nayagam in Apley and Solomon's Concise System of Orthopaedics and Trauma, 2014
These functions are compromised if the menisci are torn or removed. The medial meniscus is less mobile than the lateral and, consequently, more liable to tearing when subjected to abnormal stresses. Grinding forces split the fibres of the meniscus (which are arranged circumferentially). If the separated fragment remains attached at the front and back, the lesion is called a bucket-handle tear. The torn portion sometimes displaces towards the centre of the joint and, if jammed between femur and tibia, it can block the knee extending fully (‘locking’). If the tear emerges at the free edge of the meniscus, it leaves a tongue based anteriorly (an anterior horn tear) or posteriorly (a posterior horn tear).
Rongjin Niantong Fang ameliorates cartilage degeneration by regulating the SDF-1/CXCR4-p38MAPK signalling pathway
Published in Pharmaceutical Biology, 2022
Jun Chen, Nan Chen, Ting Zhang, Jie Lin, Yunmei Huang, Guangwen Wu
Thirty rats were randomly divided into the blank, model, and treatment groups (n = 10). After a week of routine feeding, rats were anaesthetised by intraperitoneal injection of 3% pentobarbital sodium (30 mg/kg). (Liu et al. 2005; Chen et al. 2016; Wu et al. 2019; Xu et al. 2021). Briefly, the rat model of OA was established using modified Hulth’s method in all groups except the blank group. A 1 cm longitudinal incision was made on the skin of the medial right-posterior knee, the medial collateral and anterior cruciate ligaments were transected via the medial approach, and the medial meniscus was removed. Then the joint capsule was sutured layer by layer. The blank group only received a 1 cm longitudinal incision on the skin of the medial right-posterior knee, and the skin was sutured. A prophylactic antibiotic with sodium penicillin (200,000 units) was given 3 days after surgery. The drawer test was used to determine whether the cruciate ligaments were transected.
Biomechanical study of medial meniscus after posterior horn injury: a finite element analysis
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2020
Peishi Jiang, Juncheng Cui, Zhiwei Chen, Zhu Dai, Yangchun Zhang, Guoliang Yi
Posterior root tear of medial meniscus is commonly found in elderly patients and is often closely related to meniscus protrusion and osteoarthritis (Lee et al. 2011). When the posterior horn of medial meniscus is damaged, the meniscus annular stress often disappears, thereby narrowing joint space and leading to change in mechanical environment of lateral meniscus. The 1/3 of medial meniscus resists knee joint external rotation (Allaire et al. 2008; Jie Xingang et al. 2010). When the tibia of knee joint is externally rotated, medial and lateral meniscus posterior horn are closely attached to femoral medial malleolus and to femoral lateral condyle, respectively. Allaire et al. have shown that after medial meniscus injury, the extorsion angle of tibia increases by 2.98°, while the lateral translation increases by 0.84 mm. The increase of tibia extorsion further intensifies contact stress between meniscus and femur. Moreover, increasing outward shift of tibia occurs, thus leading to increases of relative displacement after lateral meniscus anterior horn became closely attached to femoral lateral condyle, resulting in anterior horn tear of lateral meniscus.
An algorithmic approach to rehabilitation following arthroscopic surgery for arthrofibrosis of the knee
Published in Physiotherapy Theory and Practice, 2018
During a recreational flag-football game, this 30-year-old male pivoted and felt a pop in his right knee. MRI revealed a tear of the ACL and posterior horn of the medial meniscus. He underwent a bone patella bone ACL autograft and partial medial meniscectomy followed by a standard postoperative ACLR rehabilitation protocol. His surgery and rehabilitation was performed at an outside facility, so the quality of this patient’s postoperative course is unknown. Notes from his medical chart documented a 5° loss of knee extension ROM at his discharge from physical therapy, but the patient had been cleared to begin a running program when he developed increased pain and stiffness to his right knee. A follow-up MRI revealed an intact ACL graft with a Cyclops lesion within the intracondylar notch and an osteochondral defect of the lateral tibial plateau. The patient underwent arthroscopic surgery for removal of the scar tissue and physical therapy was initiated within 2 weeks of the procedure.
Related Knowledge Centers
- Femur
- Fibrocartilage
- Meniscus
- Tibia
- Knee
- Medial Condyle of Femur
- Medial Condyle of Tibia
- Lateral Meniscus
- Transverse Ligament of Knee
- Coronary Ligament of The Knee