Knee
Meniscal Tear
반월판 파열
Tear of the fibrocartilaginous meniscus causing pain, locking, and giving way
- How common
- Common
- Typical age
- All ages (traumatic: young; degenerative: middle-aged)
What is it?
The meniscus distributes load, absorbs shock, and stabilizes the knee. Torsional stress tears the fibrocartilage — bucket handle tears cause mechanical locking; horizontal tears cause degenerative pain.
Commonly affected: Medial meniscus posterior horn (most common); lateral meniscus in ACL injuries
How it develops
- Torsional ForceAxially loaded knee suddenly rotates — shear stress tears the meniscus
- Fibrocartilage TearMedial meniscus posterior horn most commonly torn (least mobile)
- Fragment DisplacementBucket handle tear displaces into intercondylar notch — mechanical block to extension
- Joint EffusionVascular outer zone tear causes hemarthrosis; avascular inner zone causes serous effusion
Symptoms
- Joint Line TendernessPoint tenderness specifically at medial or lateral joint line
- Mechanical LockingInability to fully extend knee — pathognomonic of bucket handle tear
- Delayed EffusionEffusion develops over hours (vs immediate in ACL — blood from vessels)
- Giving WaySudden knee giving out during activity — reflex inhibition of quadriceps
- Pain with SquattingSquatting or deep flexion reproduces meniscal pain
How it is examined
- Positive McMurray TestKnee flexion + tibia rotation: palpable/audible click at joint line = positive
- Apley Compression TestProne position: axial compression + rotation reproduces joint line pain
- Joint Line TendernessSpecific tenderness at medial or lateral joint line
Imaging
X-ray doesn't show meniscal tears but rules out fracture and shows joint effusion (fat pad displacement).
- Joint effusion (soft tissue density)
- Rule out fracture
- Assess for concurrent OA
MRI is gold standard (>90% sensitivity/specificity). Shows tear pattern (bucket handle, radial, horizontal, flap).
- Intrameniscal T2 signal (tear)
- Bucket handle: double PCL sign
- Joint effusion/hemarthrosis
- Assess concurrent ACL status
Non-surgical care
- RICE Protocol (Acute)Rest, Ice, Compression, Elevation for acute management
- Physical TherapyQuad strengthening, ROM exercises — effective for degenerative tears in older patients
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Mechanical symptoms (locking), traumatic tear in young patient, failed conservative care
Procedures that may be discussed
- Arthroscopic partial meniscectomy (most common)
- Meniscal repair (vascular red-red zone tears in young patients)
- Meniscal transplantation (total meniscectomy)
Outlook
Partial meniscectomy 80–90% good results. Repair preserves meniscal function — preferred in young patients.