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Knee meniscus injuries: causes, symptoms, diagnosis, treatment
Last reviewed: 04.07.2025
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ICD-10 code
- M23.6 Other spontaneous ruptures of knee ligament(s).
- M23.8. Other internal disorders of the knee.
- S83.2. Meniscus tear, fresh.
Epidemiology of meniscus injury of the knee joint
Meniscus injuries are the most common intra-articular injury to the knee joint, accounting for 77%.
[ What causes knee meniscus damage?
The mechanism of meniscus rupture is most often associated with its compression between the articular surfaces during sharp flexion or extension in the knee joint, especially in combination with rotation of the hip with a fixed shin. Damage to the medial meniscus occurs 5-10 times more often than to the outer one. This is due to the fact that the medial meniscus is more firmly fused with the joint capsule and the tibial collateral ligament, which make it less mobile. Meniscus ruptures can be longitudinal, like a "watering can handle", as well as anterior or posterior horns. The latter occur 4 times less often than ruptures in the anterior section.
Symptoms of Meniscus Injury in the Knee Joint
Following the typical mechanism of injury, there is a sharp pain in the knee joint and a limitation of active and passive movements - "joint block". An attempt to move it, especially in the direction of extension, sharply increases the pain.
Often, under the influence of treatment or spontaneously, the knee joint blockade disappears, the pain syndrome and secondary synovitis phenomena decrease. An imaginary "recovery" occurs. But subsequently, the slightest awkward movement, repeating the mechanism of injury, can cause a relapse of the knee joint blockade. Sometimes it is severe and does not disappear without medical assistance, and in some cases the patient eliminates it himself by swinging and rotating movements of the shin. Joint pain lasts 1-2 days, synovitis is insignificant or absent. Patients do not seek medical help. Such attacks of blockades begin to recur and can occur several times a month, week or even day, which forces the patient to seek medical help.
Where does it hurt?
Diagnosis of meniscus damage in the knee joint
Inspection and physical examination
Palpation reveals pain along the joint space in the projection of the meniscus. The joint swells. Hemarthrosis and reactive effusion of synovial fluid create a picture of the presence of free fluid in the knee joint - symptoms of flailing and balloting of the patella. The shin is in a forced position: bent at an angle of 30-40°.
When examining patients with old meniscus tears, signs characteristic of this untreated injury are identified.
Atrophy of the thigh muscles is one of the objective signs of knee joint disease. If you ask the patient to raise the leg extended at the knee joint, you can detect flattening of the belly of the internal broad muscle of the thigh on the affected side and more clearly defined contours of the sartorius muscle - Chaklin's symptom.
The knee joint is slightly bent, and a palm can always be placed under it (the "palm" symptom) in a patient lying on the couch. AM Landa described this sign as a symptom of flexion contracture.
When palpating the joint space in the area of the damaged meniscus with the knee joint bent, moderate pain is detected, and if you leave your finger in this place and straighten the patient's leg, the pain increases significantly - N.I. Baykov's symptom.
Many patients exhibit a positive V.P. Perelman symptom: going down stairs is more difficult due to pain than going up.
Laboratory and instrumental studies
Since the meniscus rupture is not visible on the general X-ray of the knee joint, they resort to the introduction of contrast agents or air. But such studies are not always reliable. Currently, arthroscopy has become an aid in the clinical diagnosis of internal injuries of the knee joint.
Differential diagnostics of meniscus damage of the knee joint
In the acute period, the pathology is differentiated from a rupture of the capsule and ligamentous apparatus, a contusion and an intra-articular fracture; in the chronic stage - from meniscopathy, meniscosis and meniscus cyst.
What do need to examine?
How to examine?
What tests are needed?
Treatment of meniscus damage in the knee joint
Conservative treatment of meniscus damage of the knee joint
If there is a blockade of the knee joint, it is eliminated. The knee joint is punctured, the contents are evacuated and 10 ml of a 1% solution of procaine is introduced into the cavity. The patient is seated on a high stool or table so that the thigh lies on the plane of the seat, and the shin hangs at an angle of 90°. After waiting 10-15 minutes from the onset of anesthesia, they begin to eliminate the blockade.
The manipulation is performed in four stages:
- the first stage is downward traction of the foot;
- the second stage is the deviation of the lower leg to the side opposite the pinched meniscus;
- the third stage is rotation of the lower leg inward and outward;
- fourth stage - freely, without effort, straighten the lower leg.
If the attempt fails, it should be repeated, but no more than 2-3 times. After the blockade is eliminated, a posterior plaster splint is applied from the fingertips to the upper third of the thigh for 3-4 weeks, UHF and static gymnastics are prescribed. After the end of immobilization, rehabilitation treatment is carried out.
Surgical treatment of meniscus damage of the knee joint
In case of repeated blockades, surgical treatment is indicated in the same way as in cases where conservative blockade elimination failed. The operation consists of opening the joint via parapatellar access and its revision. If a torn meniscus is detected, it is resected along its entire length. The remaining mobile sections of the meniscus (usually the posterior horn) can again cause "blockades" of the knee joint. The wound is sutured layer by layer. A posterior plaster splint is applied for 2 weeks. Walking on crutches is indicated for 3 weeks. Exercise therapy and physiotherapy are prescribed from the 3rd day.