Medial Meniscus Syndrome

James Carmichael

Background:

Of the menisci within the knee, it is the medial that is more easily injured. Differences in the anatomical attachments of the medial meniscus compared to the lateral mean that the medial meniscus becomes distorted during combined flexion and rotation movements in a manner not experienced on the lateral side.

Mechanism of Injury:

Medial meniscal injuries are usually considered as either traumatic or degenerative. Whilst degenerate tears may present with a gradual history of increasing symptoms, traumatic injuries will usually occur as the knee is extended and rotated from a flexed position against resistance. This may occur as a single event during a sporting endeavour or during a period of unaccustomed squatting such as laying flooring or playing with children. The most commonly injured area is the posterior horn.

Presentation:

The exact presentation of a medial meniscal injury will vary according to the morphology of the tear sustained. Meniscal tears can be simply divided into vertical longditudonal, vertical radial, horizontal or complex. Presentation of a meniscal tear may be through:

1. Locking: The inability to extend the affected knee to the same extent as the contralateral side. Crucially this is due to a mechanical block and whilst pain may be a feature it is not the sole reason the knee is unable to extend. This presentation is caused by a bucket handle tear (an unstable vertical longitudinal tear) prolapsing out of position creating the mechanical block to movement.
2. Pain: This is characteristically intermittent in nature and associated with activities such as stair climbing, running or sleeping with knees together. Patients will often complain of an inability to fully squat and may exhibit tenderness along the joint line of the affected
   knee.
3. Swelling: In large peripheral tears the injury may be associated with
   
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