Medial Meniscal Tear in a Long Distance Runner

Abstract

HISTORY: A 53 year-old male distance runner presents with a complaint of right medial knee pain for the past 3 years, Pain came on gradually and has worsened to the point where he is now unable to run more than one mile without experiencing excruciating pain that requires him to stop. He was previously an avid marathon runner who ran approximately 30-60 miles a week regularly. He reports no trauma to the knee nor any twisting or locking instances and had undergone physical therapy two years ago with minimal relief. No swelling, instability or locking of the knee. PHYSICAL EXAMINATION: Normal gait with walking and running. No pain with running a distance of 100 feet. The left knee was normal in appearance with no effusion or deformity. It exhibited full range of motion and intact strength. The right knee exhibited no effusion or deformity. There was moderate tenderness to palpation over the medial joint line. There was 5/5 strength and full range of motion on flexion and extension. The Lachmann’s test was negative. Varus/valgus tests negative. McMurray’s test negative. Patellar compression and apprehension tests negative. DIFFERENTIAL DIAGNOSIS: 1. Patello-femoral syndrome. 2. Degenerative joint disease. 3. Meniscal tear. TEST AND RESULTS: 1. Upright standing anterior-posterior and lateral views of the right knee:-Mild tri-compartmental osteoarthritis of the right knee with small supra-patellar effusion 2. MRI right knee without contrast: -Tear of the medial meniscal body and posterior horn with extruded flipped fragment of the body into the medial meniscal tibial recess. -Deep oblique fissure of the medial facet of the patella. -Mild lateral patellar subluxation and lateral tilt. FINAL WORKING DIAGNOSIS: Right knee medial meniscal tear with extruded flipped fragment of body into meniscal tibial recess. TREATMENT AND OUTCOMES: 1. Referral to physical therapy for right knee range of motion exercises and quadriceps and hamstring strengthening. 2. Referral to our sports orthopaedic surgeon for possible arthroscopy and meniscal repair. 3. Home exercise program to work on quad and hamstring strengthening as instructed by physician and physical therapist. 4. Will monitor progression with physical therapy and await recommendations from orthopaedic surgery colleagues.