Cartilage tear

Alternative names
Tear - meniscus; Knee injury - meniscus; Cartilage tear

Definition

Meniscus tears describes a tear in the shock-absorbing cartilage (meniscus) of the knee.

Considerations
A physical examination shows signs of torn meniscus. This includes various manipulations of the joint.

     
  • Pain on the joint line in the area of the meniscus tear.  
  • In the McMurray’s test, the health care practitioner will have you lie on your back while holding the heel of your injured leg with your leg bent. Pressure is placed on the outside of the knee with the practitioner’s other hand, and the leg is straightened with the foot turned in (internally rotated). Pain and/or a click over the inner part the joint indicate an inner (medial) meniscal tear.  
  • For an Apley’s compression test, the health care practitioner will have you lie on your back with your knee bent at a 90 degree angle. The practitioner will grab your foot with both hands and rotate it to the outside (lateral rotation) while a downward force is applied to the foot. The practitioner’s knee and thigh may be used to stabilize your thigh. Pain in the inner part of the joint may indicate an inner (medial) meniscal tear.  
  • A ballottement test for synovial effusions (excess joint fluid) is positive in meniscal tears, indicating swelling with fluid around the joint. This test is a physical examination test that allows the practitioner to detect the presence of fluid in a body space.

Other tests that show meniscus tears may include:

     
  • a knee MRI  
  • a knee joint X-ray

Causes
The meniscus is a C-shaped fibrous piece of cartilage which is found in certain joints and forms a buffer between the bones to protect the joint. The meniscus also serves as a shock-absorption system, assists in lubricating the joint, and limits the joint flexion and extension.

Meniscal tears are most commonly caused by twisting or hyperflexion of the joint.

Symptoms

     
  • a “pop” noted at the time of injury  
  • joint tenderness may be noted  
  • knee pain       o often perceived as being located in the space between the bones       o worse when gentle pressure is applied to the joint (palpation)  
  • recurrent knee-catching  
  • locking of the joint

First Aid

The goal of treatment is to minimize the symptoms and protect the joint from further injury while it heals.

Full weight bearing is discouraged (the person may need to use crutches). A knee immobilizer is often applied to prevent further injury to the joint. Ice is applied to reduce swelling, and nonsteroidal antiinflammatory drugs (NSAIDS) are given to reduce swelling and pain.

Physical activity is allowed - as tolerated. Physical therapy should be involved to help regain joint and leg strength. If the injury is acute, and/or you have a high activity level, knee arthroscopy (surgery) may be necessary. Age has an effect on treatment. Younger patients are more likely to have problems without surgery.

Do Not

     
  • DO NOT force weight bearing, if painful

Call immediately for emergency medical assistance if
Call your health care provider if symptoms of meniscus tears occur after an injury to the knee.

Call your health care provider if you are being treated for a meniscus tear and you notice increased instability in your knee, if pain or swelling return after they initially subsided, or if your injury does not appear to be resolving with time.

Also call if you re-injure your knee.

Prevention
Use proper technique when exercising or playing sports. Many cases of meniscus tears may not be preventable.

Johns Hopkins patient information

Last revised: December 4, 2012
by Amalia K. Gagarina, M.S., R.D.

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