Recommendations from others
The American Academy of Orthopaedic Surgeons’ clinical guideline on the evaluation and treatment of knee injuries lists the following findings as associated with a meniscal tear: delayed swelling of the knee, twisting injury, painful popping and catching, effusion, joint line tenderness, positive McMurray’s test, and negative radiography.6 The guideline fails to list the strength and type of supporting evidence for these associations.
The American College of Radiology’s Appropriateness Criteria for Acute Trauma to the Knee states that decision rules for meniscal tears and other soft tissue injuries to the knee are being investigated, but it fails to mention specific evaluation strategies for meniscal tears.7
CLINICAL COMMENTARY
Meniscus injury likely with suggestive history, joint line tenderness, and an inability to squat because of pain
Roy Henderson, MD
Director, Sports Medicine Fellowship, MacNeal Family Practice Residency Program, Chicago, Ill
I often suspect meniscal injuries as a cause of knee pain but am rarely certain based on physical examination alone. I look for a history of joint line pain, locking, or popping with movement. If the patient lacks joint line tenderness, a meniscal injury is unlikely. The McMurray test is usually negative. In the absence of another explanation for the patient’s symptoms, a meniscus injury is high on my list in the presence of a suggestive history, joint line tenderness, and an inability to squat because of pain. When my suspicion is high I usually resort to an MRI.