1. Meniscal Injuries

2. Normal Anatomy Wedge shaped Fibrocartilage Lateral meniscus more mobile than medial meniscus Provide shock absorption in weight bearing, stabilise joint, prevent hyperextension Peripherally good blood supply, centrally poor blood supply

3. Mechanism of Injury Weight bearing twisting Hyperflexion Popping or tearing sensation at time of injury Degenerative overuse

4. Classification

6. Associated Pathologies ACL injury MCL / LCL injury ‘Unhappy triad’

7. Subjective History of twisting injury with foot anchored Forced hyperflexion Tearing sensation or an audible pop Small tears may become painful / swell over following 6 -24 hours Locking – associated with larger tears

8. Objective Joint line tenderness Joint effusion Crepitus Pain on flexion Loss of flexion (>10 o ) Pain on extension Loss of extension (>5 o )

9. Special Tests McMurray Test Apley’s Test “Bounce Home” Test Thessaly Ege’s Axial loaded pivot shift

10. Clinical Prediction Rule 1.History of catching or locking 2.Joint Line Tenderness 3.Pain with forced hyperextension (modified bounce home test) 4.Pain with maximal passive knee flexion 5.Pain or audible click with McMurrays 3/5 = 76.7% Positive Predictive Value (PPV) 4/5 = 81.8% PPV 5/5 = 92.3% PPV

11. Further Investigation MRI Diagnostic Arthroscopy

12. Management Non-Surgical Symptoms develop over 24-48 hours Minimal injury Able to weight bear Minimal swelling Full ROM (pain only at end ranges) Pain only Surgical Severe twisting injury Gross loss ROM Positive McMurray (with clunk) Associated ACL tear Little improvement following 3 weeks of conservative treatment

13. Conservative - Management – Restore Normal Mobility Decrease swelling and inflammation around the joint – Soft tissue release – Ice – NSAID’s Normalise soft tissue – Frictions to joint line including coronary ligament – Soft tissue release to surrounding soft tissue Restore normal joint mechanics – Joint mobilisations if tolerable – Do not mobilise into flexion or extension if springy block is present due to meniscal tearing – Restore Stability Motor Control and Strength – Inner Range Quads – Glutes Proprioceptive Training Return to Sport/Activity Specific Exercises

14. Surgical - Management Meniscal resection Partial meniscectomy Meniscal repair Tears in the outer third of the meniscus can heal as there is blood supply to this area