Authors: Colin Ayre & Lauren Womersley

PROTOCOL: Diagnosing meniscal injuries

CLINICAL IMPLICATION INTERVENTION/ CONTRAINDICATIONS BENEFITS RISKS GOALS General examination of Subjective signs indicating possible meniscal Acutely locked knee Benefits- a patient including pathology include painful popping, twisting injury,  Correct diagnosis allows subjective and objective delayed swelling, catching, locking, clicking (AAOS, Associated fracture best possible treatment information may give 2002; Ellis et al, 2004, Solomon et al, 2001) (Solomon et al, 2001) rise to the best likelihood Unstable knee  Appropriate advice may of correct diagnosis Appleys test is not proven to be of clinical (associated ligamentous help prevent further (Solomon et al, 2001; significance in detecting meniscal tears (McAuley injury) damage McAuley and Best, and Best, 2002) 2002) Inflammatory arthritis Risks- McMurrys test may be of use in assisting diagnosis  Theoretically tests may Can be rarely certain of (Jackson et al, 2003; Scholten et al, 2001;NZGG, Infection increase the S+S or even a meniscal injury based 2002) make a tear worse. A on the objective number of patients examination alone (Ellis Weight bearing meniscal tests (Thessaly, Ege’s) exhibited worsening et al, 2004) may be more sensitive in picking up meniscal Cautions symptoms with weight lesions than traditional tests (Akseki et al, 2004; bearing meniscal testing Karachalios et al, 2005) but may be associated with Degenerative knees (Karachalios et al, 2005) increased pain or even cause a joint to lock (OA)  Testing is not 100% following testing (Karachalios et al, 2005). They accurate and may leave should maybe therefore only be used when the clinician with a false diagnosis is uncertain impression Block to knee joint extension may be of use especially in the presence of joint line tenderness (NZGG, 2002)

Joint line tenderness may also be of use in determining meniscal injury especially in combination with other tests (NZGG, 2002; Karachalios et al, 2005)

Authors: Colin Ayre & Lauren Womersley Date Protocol Introduced: August 2006 Review Date: August 2009 Contact: Colin Ayre 5322 LIMITATIONS GOAL RELATED KEY EVIDENCE AUDIT TARGETS OUTCOME MEASURE Studies use experienced All physiotherapists  Akseki D, Ozcan A, Boya H, Pinar H. A new weight-bearing meniscal test and a Review in July 2009 comparison with McMurray’s test and joint line tenderness. Atrhroscopy. 2004. handlers to assess knees should be assessing 20: 951-8 potential meniscal  Ellis M.R. Griffin K.W Meadows S. For knee pain, how predictive is physical examination for meniscal injury? J Fam Pract 2004; 53, 11 Studies often only injury as per the  Jackson JL, O’Malley PG, Kroenke K. Evaluation of acute knee pain in primary included suspected protocol care. Ann Intern Med 2003;139:575–588.  Karachalios T. Hantes M, Zibis V, Karantanas A.H. Malizos K.N. Diagnostic meniscal pathologies and accuracy of a new clinical test (the thessaly test) for early detection of meniscal not other knee conditions This should include tears. J Bone Joint Surg Am. 2005;87(5):955-62.  McAuley D, Best TM (2002). Evidence based sports medicine. London. BMJ both subjective and  O’Shea K.J. Murphey K.P. Heekin R.D. Herzwurm P.J. The diagnostic accuracy Lacking adequate control objective testing as of history, physical examination, and radiographs in the evaluation of traumatic groups identified knee disorders. American Journal of Sports Medicine 1996, 24: 164-167  Scholten RJ, Deville WL, Opstelten W, Bijl D, van der Plas CG, Bouter LM. The accuracy of physical diagnostic tests for assessing meniscal lesions of the Often the composite/ knee: a meta-analysis. J Fam Pract 2001;50:938–944.  Solomon DH, Simel DL, Bates DW, Katz JN, Schaffer JL. The rational clinical general examination has examination. Does this patient have a torn meniscus or ligament of the not been accurately knee?. JAMA 2001;286:1610–1620.  American Academy of Orthopaedic Surgeons. AAOS Clinical Guideline on identified Knee Injury: Support Document. Last updated February 26, 2002. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 2001. Available at: http://www.guidelines.gov. Accessed on September 30, 2004.  American College of Radiology (ACR) Expert. Panel on Musculoskeletal Imaging ACR Appropriateness Criteria for Acute Trauma to the Knee. Updated October 1, 2002. Reston, Va: American College of Radiology; 2001. Available at: http://www.guidelines.gov.  New Zealand Guidelines Group – NZGG. The diagnosis and management of soft tissue knee injuries: internal derangements. Wellington (NZ): 2003 Jul. 100 p. [229 references]. Available at www.guideline.gov/summary/summary.