Symptoms | Torn meniscus symptoms, diagnosis and treatment

Symptoms

Various examination methods of the treating orthopedic surgeon in case of a meniscus tear help to make a diagnosis, but also to exclude other diseases by differential diagnosis (see: Diagnosis) Meniscus tear The main symptom of a meniscus tear is severe pain in the affected knee. The character of the occurring pain is basically determined by the underlying disease. Thus, an acute meniscus tear, which occurs for example as a result of a sports injury, manifests itself in sudden, severe pain.

Chronic cartilage wear, which is accompanied by a meniscus tear, is manifested by a gradual worsening of the pain. In general, the pain usually occurs especially during exertion. In the course of the disease, the pain may also occur when standing or sitting for a longer period of time. The signs of a torn meniscus are usually triggered by cartilage fragments that are located in the joint space and cause the typical pain there.

Diagnosis of a torn meniscus

During the manual examination for meniscus tears, the physician checks the so-called “special meniscus signs” by means of so-called meniscus tests. For this he uses proven standard tests, e.g. standard tests according to: Here, an attempt is made to press the thigh and lower leg joint surfaces together in various forms, for example in the stretching, bending and twisting positions. Within the scope of the examination methods, injuries of the outer meniscus can be distinguished from injuries of the inner meniscus.

Various meniscus tests also provide information about the location of the tear. The standard test according to Payr indicates an injury in the posterior horn area of the inner meniscus when pain occurs. Every diagnosis of meniscus damage begins with the manual examination by the physician described above.

To confirm this diagnosis of meniscus damage, additional diagnostic methods are also used.

  • Stone Man
  • Apley – Grinding
  • Boehler
  • McMurrayand
  • Payr

As already mentioned in the context of the therapy forms, there are different forms of meniscus tear. Depending on the location of the injury in the meniscus tissue, the following types of tears can be distinguished in the area of the inner as well as the outer meniscus: The physician can determine which form of meniscus rupture is present by means of various examination methods, usually manual examinations, to which x-ray image diagnostics is also added.

  • Torn basket handle (= longitudinal meniscus tear with displacement of torn meniscus parts into the joint)
  • Transverse tear (from the free edge to the base)
  • Flap tear in the posterior or anterior horn (= a combination of longitudinal and transverse tear)
  • Horizontal crack (longitudinal crack, whereby an upper and lower lip is formed)
  • Tearing off the meniscus base

Here you will find detailed, usually generally generally valid information regarding the MRI: MRI At this point it should only be pointed out that over 95% of meniscus tears can be diagnosed by means of the MRI. Unfortunately, some meniscus tears cannot be visualized on the MRI, or tears are more severe under arthroscopy than can be assumed on the MRI. Due to the constant improvement of the MRI technique, the error rate in MRI for meniscus tears has decreased significantly.

MRI of the knee joint is the imaging technique of choice for meniscus tears, as it can show the cartilage tissue with the highest accuracy. This is the best way to assess the tear, its location, shape and extent. Based on the findings, the optimal therapy for the patient can then be determined.

In addition, the MRI examination allows the simultaneous detection of concomitant injuries to the knee joint (cartilage damage, cruciate ligament rupture, tear of the outer or inner ligament). It is not uncommon for other structures of the joint to be damaged in a torn meniscus, such as the cruciate ligaments, the outer or inner ligaments or the joint capsule. If the inner meniscus is injured, sometimes the inner ligament and the anterior cruciate ligament are injured simultaneously.

This constellation is also called “unhappy triad”. The MRI examination allows the entire joint to be examined and a complete set of injury findings to be made. This is the basis on which the individual therapy to be chosen for the patient is based.

While the x-ray examination is inconspicuous in the case of fresh meniscus injuries and thus provides hardly any information in the context of traumatic damage, it is very meaningful in the case of chronic damage (e.g. permanent occupational strain on the menisci). Bony changes become visible. In order to exclude possible accompanying bony injuries, an X-ray examination is carried out at least in two different levels.

Although the ultrasound examination is not routinely used because other forms of examination are more meaningful, the sonography provides information about accompanying ligament injuries. Especially swelling, water in the knee and hematoma bruises can be visualized well with the ultrasound examination. To confirm a diagnosis, an arthroscopy, i.e. a mirror image of the knee joint, can be performed.

While the physician can diagnose the interior of the joint with the utmost precision, the great advantage of arthroscopy is that under certain circumstances surgery can be performed immediately. Due to the good image quality of the MRI ́s in the case of a torn meniscus, arthroscopy of the knee joint is practically not performed today for diagnostic reasons. In the “keyhole operation”, the knee is only opened through a small skin incision.

A rod, which transmits images from the inside of the joint to a monitor in the operating room by means of a camera, is inserted into the knee joint through this small incision. Another small incision allows the insertion of a tactile hook, which tests the condition of cartilage, cruciate ligament and menisci. This second incision can then be used to insert further instruments, so that, for example, exposed parts of the meniscus can be removed directly. In cases requiring surgical treatment (knee arthroscopy), additional examinations such as an ECG and/or laboratory check of blood values are also necessary.