Meniscal Injury

Meniscal Injury is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • The menisci are fibrocartilaginous structures between the femoral condyles and tibial plateaus.
  • The menisci help stabilize the knee and distribute forces across the joint.
  • There are acute/traumatic and chronic/degenerative meniscal tears.

Geriatric Considerations
Meniscal tears in older patients are typically due to chronic degeneration.

Pediatric Considerations
  • Meniscal injuries are rare in children <10 years old and are often due to a discoid meniscus (anatomic variant that is thicker and wider).
  • MRI is less sensitive and specific for diagnosing meniscal tears in children <12 years of age.

Epidemiology

Bimodal age distribution—young athletes (traumatic) and older patients >40 years (degenerative)

Incidence
Medial meniscus more commonly injured

Prevalence
One of the most common musculoskeletal injuries

Etiology and Pathophysiology

  • Acute/traumatic tears occur due to a twisting motion of the knee with foot planted.
  • Chronic/degenerative tears occur with minimal trauma, overuse.
  • More common >40 years old

Genetics
Presence of a discoid meniscus increases the risk for a meniscal tear. No specific gene locus has been identified.

Risk Factors

  • Acute/traumatic
    • High degree of physical activity (especially cutting sports)
    • Anterior cruciate ligament (ACL) insufficiency
  • Chronic/degenerative:
    • Increased age (>60 years)
    • Obesity
    • Work related kneeling/squatting/climbing stairs

General Prevention

  • Treatment and rehabilitation of previous knee injuries, particularly ACL injuries
  • Strengthening and increased flexibility of quadriceps and hamstring muscles

Commonly Associated Conditions

  • Acute/traumatic:
    • ACL is concomitantly torn in 1/3 of cases.
  • Degenerative
    • Baker cyst—association with medial meniscal tears
    • Osteoarthritis (OA)—degenerative tears can be considered as an early stage of OA.

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