Clinical features

The clinical features of a meniscal tear are characteristic:

• often history of sports related injury with twisting of the knee
• severe pain such that further movement / games play is immediately prevented
• if there has been a tear of the medial meniscus, which is more frequent, then the pain is localized to the anteromedial joint line; the pain that occurs with a lateral tear is far more diffuse
• knee may 'lock out'
• swelling around knee appears some hours, or even days, after the injury
• initial symptoms are relieved by rest; symptoms reappear after trivial twists or strains of the knee

Signs:

• the knee may be held slightly flexed
• an effusion may be present
• localized tenderness over the medial joint is typical of a medial meniscus tear; tenderness on the lateral side is less well-localized;
• extension is often limited; flexion is generally not reduced
• McMurray's or Apley's grinding test may be positive
• Thessaly test at 20 degrees flexion is accurate in the detection of meniscal tears (1)
• quadriceps muscle will be wasted in long-standing cases
  
  

Between attacks the knee may be surprisingly asymptomatic.

Reference:

1. Karachalios T et al. Diagnostic accuracy of a new clinical test (the Thessaly test) for early detection of meniscal tears. J Bone Joint Surg Am 2005;87:955-62