Meniscal injuries: A critical review.

Although once perceived as an unimportant vestigial structure, the menisci of the knee are now known to be a common source of knee pain and disability. The medial meniscus is more vulnerable to injury to due to its intimate attachment to the medial collateral ligament. The moveable lateral meniscus is less prone to tear except when the ACL is injured. The medial and lateral menisci are usually injured as a result of sudden knee flexion with a component of knee internal or external rotation. However, older patients may present without a specific mechanism of injury as their meniscal injuries are often due to degenerative processes. Most meniscal injuries can be diagnosed with a thorough physical examination utilizing the McMurray, Apley, and ``bounce home'' maneuvers. Joint line tenderness and the presence of a knee effusion aid in the diagnosis. Magnetic Resonance Imaging (MRI) has become the test of choice in confirming injury. MRI also defines the type, location, and severity of meniscal injury. Some meniscal injuries, particularly peripheral, well-vascularized tears, may be more prone to healing with nonsurgical management. Typical initial management includes reduction of swelling and pain. Rehabilitation stresses tri-planar functional retraining. The final phases of rehabilitation incorporate a functional progression to sports or work specific activities. Arthroscopic knee surgery has become a prevalent treatment method for bucket handle tears and non-vascularized meniscal injuries. Meniscal repair is currently preferred over partial menisectomy to avoid premature osteoarthritis. In sum, clinicians can return patients with meniscal pain to a high level of function with appropriate recognition of injury and functional rehabilitation.