Meniscal tears - Question and Answer

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Everything you wanted to know about meniscal tears but were afraid to ask

Anatomy and function

1. What is the meniscus?
2. What does meniscus mean in Greek? Meniscus means crescent in greek.
3. What are the three jobs of the meniscus (and, therefore, what are the consequences of losing it)? It helps with tensile, compressive, and shear stress of the knee
4. Where is the blood supply to the meniscus? The blood supply of the meniscus comes from the medial and lateral genicular arteries. The middle genicular artery supplies the vascular synovial covering of the anterior and posterior horn attachments.
5. Which ligaments hold the meniscus in place?
6. Where are the nerves in the meniscus (and what type are they)? The posterior articular nerve from the posterior tibial nerve supplies the meniscus. Mechanoreceptor function predominates at the horns.

Diagnosis

1. What is the "classic" story for an athletic meniscal tear?
2. What findings on physical exam suggest a meniscal tear?
3. What suggests specifically a displaced bucket handle tear?
4. What maneuvers can be done to enhance physical diagnosis
5. What is the sensitivity and specificity of these maneuvers?
6. How accurate is MRI?
7. What is the KEY question to decide whether to order an MRI?
8. What is the likelihood that an MRI of the knee ordered by an orthopedic surgeon will be normal vs the odds that an MRI of the knee ordered by primary care physician will be normal (normal = normal or DJD only)
9. What is the role of plain films in the diagnosis of meniscal tears?
10. What is the likelihood that a 70 year old has a meniscal tear if his/her knee hurts?
11. What is the correct response to the question "Does the 'unhappy triad' include a medial or lateral meniscal tear?"

Treatment

1. Approximately how many meniscal procedures are done in the U.S., and what percentage of all orthopedic procedures does this number represent?
2. Which meniscal tears are amenable to repair?
3. Which tears should be resected?
4. Which tears should be watched and treated with PT, NSAIDs, etc?
5. What is the likely outcome from meniscal repair?
6. What is the likely outcome from meniscal resection (ie, who is Fairbank?)
7. What are the risks of complications from meniscal surgery?
8. How much of this is evidence based?

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