Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

Featured on Channel NewsAsia

Meniscus Tear

SYMPTOMS

Effusion and exercise-induced pain often combined with mechanical problems of locking, clicking, clunking or discomfort on impact (compression and rotation). This injury is common in sports such as football, rugby and other high-intensity contact sports but is also common, with no major trauma, as degenerative tears in older athletes or sedentary individuals.

AETIOLOGY

In many cases this injury occurs from direct or indirect trauma or in association with other ligament injuries. It can occur from around 10 years of age and throughout life. Note! There are numerous ways the meniscus can rupture: horizontal, vertical, bucket handle or complex tears. The tear can be localised posteriorly, centrally or anteriorly, causing different symptoms and signs.

CLINICAL FINDINGS

There is effusion in most cases. The compression rotation test is positive. There is often tenderness on palpation of the affected joint line and there are complementary tests for the same purpose. Note! Since there are often associated injuries, examination must include tests for ligaments, cartilage and capsular structures.

INVESTIGATIONS

Clinical examination is the most important tool for diagnosis and should include tests for all ligaments and other structures in the knee. X-ray is valuable to rule out fractures and severe osteoarthritis. MRI can sometimes miss significant meniscus injuries but is more important for evaluating associated injuries.

TREATMENT

An athlete with effusion and suspected meniscus injuries should be seen by an orthopaedic surgeon to consider arthroscopy. This procedure can verify the diagnosis and deal with associated injuries. Meniscus injuries are trimmed or vaporised and partially excised. Loose bodies are excised. Meniscus injuries in the periphery can sometimes be sutured, which results in longer morbidity before a return to sport but better future protection for the knee. Meniscus re-implantation is experimental surgery and the long-term outcomes are not clear. Note: a meniscus tear should be treated for its symptoms. A non-symptomatic tear, seen on MRI, does not require surgery.

REFERRALS

Refer to Dr Kevin Yip, orthopaedic surgeon (+65 9724 1219) for further investigations to verify the extent of the injury. Physiotherapists will be involved in close collaboration with the surgeon.

EXERCISE PRESCRIPTION

Cycling and swimming (not breast stroke) are good alternatives to keep up general fitness. Rehabilitation back to full sport usually takes a long time if micro-fracture is performed.

EVALUATION OF TREATMENT OUTCOMES

Monitor clinical symptoms and signs. Different functional knee scores for different sports are available to
measure when the knee allows a return to full sport.

DIFFERENTIAL DIAGNOSES

Cartilage injury, loose bodies, medial plica syndrome; all differentiated by arthroscopy.

PROGNOSIS

Surgery (partial excision, timing or meniscus suture) will allow a return to professional sports in two weeks to several months. The knee will be more vulnerable to stress at the site of meniscus excision and in the long term, 10 to 20 years, the risk of developing local osteoarthritis is significant compared to a non-injured knee.

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