History

Patients typically recall an acute sudden twisting mechanism that caused the onset of pain. Degenerative tears may be more subacute in nature and subtle in onset with underlying arthritic or baseline pain that has now become localized and sharp. A detailed history of previous knee pain, previous surgeries in the knee, and other injuries (ligament injury, fracture) should be elicited.

Symptoms

Physical Examination

A thorough knee examination is crucial because meniscal tears are commonly associated with other injuries, such as anterior cruciate ligament injuries and tibial plateau fractures. A detailed knee examination has been consistently shown to be reliable in diagnosis of a meniscal tear.

Specific findings for meniscal tears may include the following:

Imaging

Baseline plain radiography is of limited importance for diagnosis of meniscal disorders but is necessary to rule out other pathologic processes such as stress fracture, avascular necrosis, tumor, and arthritis that may mimic meniscal signs and symptoms. Standard radiographs include a 45-degree flexed posteroanterior view, weight-bearing anteroposterior view, lateral view, and Merchant view.

Magnetic resonance imaging is not a substitute for a good examination, but it can be a useful tool to confirm the diagnosis or to differentiate pathologic changes in difficult cases. Meniscal tears on magnetic resonance imaging are described as abnormal meniscal signal that extends to the articular surface of the meniscus (grade 3 meniscal signal). Numerous studies have shown that the accuracy of magnetic resonance imaging is 95% or greater for meniscal tears.

Classification

Arthroscopic evaluation has aided in the classification of meniscal tears. Meniscal tears can be classified by vascular zone or tear patterns. Both classification systems are often used in determining whether a tear is favorable for repair.

Arnoczky and Warren¹ reported on the vascularity of the meniscus, which is divided into three zones: red-red (peripheral 25% to 33%), red-white, and white-white (central 33%). Healing has been found to be more favorable in the vascular zones (i.e., red-red and red-white).

Meniscal tears are commonly described by tear pattern. Examples of common tear patterns are illustrated in Figure 52-1.

Indications and Contraindications

Meniscectomy is indicated for any symptomatic meniscal tear that is abnormally mobile or not conducive to repair and in which conservative measures have failed.

Contraindications are active septic arthritis and significant medical comorbidities.

Instruments

Multiple manufacturers have produced meniscal baskets, biters, graspers, scissors, and arthroscopic shavers. Common instruments needed for arthroscopic meniscectomy are illustrated in Figure 52-2. These include the following:

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