Medial Joint Line Tenderness Research Articles

Medial joint line tenderness is an indicator for meniscal injuries in dogs.

Medial meniscal injury is an important aspect of cranial cruciate ligament disease in dogs. This study examines whether caudomedial joint line palpation of the stifle is correlated with medial meniscal injury in canine stifles with concurrent cranial cruciate ligament disease. A total of 91 dogs (97 stifles) presenting with cranial cruciate ligament disease were assessed by palpation of the caudomedial joint line of the affected stifle by a single surgeon. Surgery was then performed to assess for injury to the medial meniscus. The odds of dogs with pain on palpation having amedial meniscal tear were then calculated, with the significance level set at p-value of 0.05. Dogs showing pain on caudomedial joint palpation had 34.5 times (95% confidence interval9.7‒125) greater odds of having a medial meniscal tear. Pain on caudomedial joint line palpation had a sensitivity of 0.86, specificity of 0.85, positive predictive value of 0.94, negative predictive value of 0.70 and accuracy of 0.86 for identifying dogs with a medial meniscal tear. The amount of pressure placed on the caudomedial joint line was not assessed and a control group was not included. Medial joint line tenderness has a significant relationship with medial meniscal tear in dogs with cranial cruciate ligament disease.

Arthroscopic Partial Meniscectomy in Adult Patient with Symptomatic Discoid Lateral Meniscus: A Case Report

Introduction: For many years, the discoid meniscus was synonymous with snapping knee syndrome. incidence of discoid lateral meniscus is estimated to be 0.4% to 17%, whereas the discoid medial meniscus is extremely rare (0.1% to 0.3%). It has been reported that about 20% of cases are bilateral. Patients with discoid lateral meniscus (DLM) often show normal plain radiography findings but may also show subtle indirect signs. Case Presentation: Female, 59 years old, complained of pain on her left knee after walking and climbing stairs for the last two months. On examination, the range of motion of knee joint was limited due to the pain for flexion more than 90°. Patient had medial joint line tenderness, and a McMurray test elicited pain on the lateral joint line. Radiographs of the left knee showed lateral joint space widening and high fibular head. Arthroscopic examination of the left knee confirmed the presence of discoid lateral menisci (DLM). Discussion: Discoid lateral meniscus (DLM), often referred to as "popping knee syndrome," is an abnormal variation of the meniscus, primarily affecting the lateral side and more common in young individuals. This condition increases the risk of knee injury, especially if the ligament attachment to the tibia is absent. In our case, radiographic findings and a positive McMurray test led to the diagnosis, confirmed by arthroscopy showing a complete DLM. While some recommend for total meniscectomy, studies suggest that partial meniscectomy can offer good initial results, though long-term outcomes may vary. Conclusion: In symptomatic DLM, surgical treatment is necessary to treat the patient. Arthroscopic partial meniscectomy is the preferred surgical procedure to treat symptomatic DLM. Keywords: Discoid lateral meniscus, arthroscopic menisectomy, WOMAC score

Correlation between Clinical Examination, Magnetic Resonance Imaging, and Arthroscopy in Meniscal Injuries of the Knee: A Prospective Cohort Study

Abstract Purpose: In comparison to magnetic resonance imaging (MRI) imaging, this study compares the diagnostic efficacy of meniscal injury with clinical examination tests such the McMurray’s test, Thessaly test, and joint line tenderness. Methodology: Two hundred and fifteen patients having a history of knee injuries with symptoms such as pain, instability, and locking were studied from June 2020 to June 2022 at our institution, for a 2-year period. Results: The sensitivity and specificity of McMurray’s test for medial meniscus were 84% and 84.21%, respectively. The sensitivity and specificity for medial joint line tenderness were 88.15% and 55.55%, respectively. Thessaly’s test for the medial meniscus was 92.10% sensitive and 88.8% specific. The sensitivity and specificity of MRI for medial meniscal injury were 94.87% and 93.75%, respectively. McMurray’s test for lateral meniscus had a sensitivity of 84.44% and a specificity of 76.92%. Lateral joint line tenderness for lateral meniscus had a sensitivity of 86.95% and a specificity of 66.66%. The sensitivity and specificity of Thessaly’s test for lateral meniscus were 93.33% and 84.61%, respectively. MRI revealed a sensitivity of 93.75% and a specificity of 90% for lateral meniscus injuries. Conclusion: Even though MRI is a precise and noninvasive method for detecting meniscal injuries, a thorough clinical examination by a skilled physician has the same diagnostic power as MRI to rule out meniscal injuries. In contrast to previous tests, the Thessaly test can be used as a useful tool to detect meniscal injuries, as we discovered in our study.

A High-Speed Ski Crash Leading to a Unique Synovial Cause for Knee Pain

The presented case involves the evaluation, diagnosis, and management of a 20-year-old male high-level skier who presented with persistent right knee pain following a ski crash. The patient reported hitting his right knee against a tree during the accident, resulting in intermittent swelling and a sensation of a mass within the knee. Despite some initial improvement in the sensation, the pain then became persistent and worsened by activity. Physical examination revealed limited symptoms during gait and functional movements, as well as restricted medial joint line tenderness and a mildly positive McMurray's test on the right knee. Magnetic resonance imaging findings prompted an orthopedic referral, leading to a right knee arthroscopy. The procedure involved resection of nodular synovitis and a diffuse synovectomy, with pathology confirming pigmented villonodular synovitis (PVNS). Despite post-operative complications, including methicillin-resistant Staphylococcus aureus bacteremia, ultimately, the patient's recovery was successful with the gradual restoration of pain-free range of motion through physical therapy. Follow-up assessments and magnetic resonance imaging scans indicated sustained improvement and no signs of pigmented villonodular synovitis recurrence.

Anterior Cruciate Ligament Ruptured Concomitant Meniscus Discoid in Young Patient: A Rare Case Report

Background: Abnormalities of the human meniscus, including discoid meniscus, double-layered meniscus, and ring-shaped meniscus, have been reported. The prevalence of discoid meniscus is extremely rare, with an incidence of 0.9%－2.4% in the Asian population. Traditionally, discoid meniscus concomitant anterior cruciate ligament (ACL) ruptures are extremely rare cases. The aim of this study is to discuss a rare case to provide diagnosis and management properly by using arthroscopy.Case Presentation: A 21-year-old male Balinese, complained of pain in his right knee after fast walking for two months and an unstable knee in the past 1 year ago. On physical examination, the range of motion was limited due to the pain for flexion of more than 90°. Special tests such as Lachman test positive, and Anterior drawer test positive. The patient had medial joint line tenderness, and a McMurray test elicited pain on the medial joint line. Meanwhile, an MRI examination of the right knee showed a discoid medial meniscus with a horizontal cleavage tear and a discoid lateral meniscus with an incomplete tear. We performed a partial meniscectomy of the incomplete discoid medial meniscus and resection of the pathologic medial patellar plica. We performed surgical reconstruction of the ACL ruptured after the meniscus was repaired.Results: We presented a 21-year-old male with discoid meniscus concomitant ACL rupture to his right knee. After the patient was performed with partial meniscectomy of the incomplete discoid medial meniscus and resection of pathologic medial patellar plica following surgical reconstruction of the ACL ruptured. The patient had no limitation of motion or pain 1 year after the operation and he had no complaints and was satisfied with the result by radiograph.Conclusion: We concluded that This rare case of medial discoid meniscus concomitant with the ACL rupture must be reconstructed. The treatment of discoid meniscus should consider its tear pattern and whether it is symptomatic. With the development of arthroscopic techniques, the treatment of discoid meniscus has gradually changed from total meniscectomy or partial meniscectomy.Keywords: anterior cruciate ligament, meniscus, discoid, knee, arthroscopy.Correspondence: I Gusti Ngurah Wien Aryana. Department of Orthopaedic & Traumatology, General Central Hospital of I.G.N.G Ngoerah Central Hospital/ Faculty of Medicine, Udayana University, Bali, Indonesia. Email: wienaryanaortho@gmail.com. Mobile: +62811-385-263.Indonesian Journal of Medicine (2023), 08(03): 317-324https://doi.org/10.26911/theijmed.2023.08.03.09

AMR Sign - An Arthroscopic S-shaped Fold Signifying Adequate Medial Meniscus Repair.

The preferred management of medial meniscus tears has notably moved from meniscectomies towards repair. With a higher volume of meniscal repairs being done all across the world with every passing day, the lack of an objective and definitive sign suggesting the adequacy of its repair is daunting. The purpose of our study was to introduce a unique and novel arthroscopic sign formed after adequate repair of the medial meniscus, the AMR (Adequacy of Medial meniscus Repair) sign. We hypothesised that it is not only the objective end point for repair, but can also form the indicator for excellent clinical, functional, and radiological outcome even in the long term. This was a multicentric, prospective study initiated by the corresponding author, and the findings validated subsequently by the other authors. Overall, it included 804 patients of isolated medial meniscus tear operated with arthroscopic all-inside technique between January 2014 and December 2017. Patients were segregated into three groups based on whether an S-shaped curve in the free, inner edge of the medial meniscus sign was formed post-repair, lost after further tightening, or not formed upon subjective completion of repair. All the patients were followed-up and evaluated based of medial joint line tenderness, McMurray's test for medial meniscus, IKDC score, WOMET score, and radiologically using an MRI at the terminal follow-up. The mean terminal follow-up was 42.34±4.54 months. There was significant (p<0.01) improvement in all patients at the terminal follow-up post-surgery, irrespective of the group. The group in which AMR sign was formed and maintained showed a significantly better functional outcome on terminal follow-up as well as lower failure rates compared to the other two groups. AMR sign is an S-shaped fold at the inner, free edge of medial meniscus, formed after an adequate repair of isolated medial meniscus tear, as viewed on arthroscopy. It is an objective sign denoting regained integrity of the collagen architecture of the medial meniscus following repair. It is also a reliable indicator of excellent long term functional, clinical, and radiological outcome and also lower failure rates in patients after arthroscopic medial meniscus repair.

Management Dilemma of a Neuropathic Knee in a Known Case of Larsen Syndrome: A Case Report.

Larsen syndrome (LS) is a rare genetic disorder affecting mainly the connective tissues. It is characterized by characteristic facial anomalies, cervical kyphosis, cardiorespiratory disorders, and multiple joint dislocations. We present a case of a 15-year-old male with unstable neuropathic knee joint instability in a known case of LS. The paucity of literature on the management of this rare condition puts an orthopedician in dilemma regarding the optimal treatment. A 15-year-old male, known case of LS, presented to our outpatient department with pain and instability in the right knee for 2 years. Clinically, the patient was having syndromic facies. The diagnosis of LS was confirmed on gene mapping. The right knee was swollen with medial joint line tenderness and restricted flexion. The patient had coronal plane valgus instability. The hypertrophied synovium eroded the articular surface. The radiograph of knee was suggestive of neuropathic arthropathy in fragmentation stage. Orthopedician should be aware of such rare entity with its bony and soft-tissue manifestations. Neuropathic knee is not an absolute contraindication to total knee replacement, especially with advanced prosthesis. Primary arthrodesis to be considered in young adults with instability.

Tenderness of the knee is associated with thinning of the articular cartilage evaluated with ultrasonography in a community-based cohort: The Nagahama study.

This study aimed to elucidate the association between joint line tenderness (JLT) of the knee and knee joint structural changes evaluated with ultrasonography (US) for the early diagnosis of knee osteoarthritis (KOA). This cross-sectional study included 121 participants (age 71.7 ± 5.8 years, 75 women) from a community-based population. Bilateral structural changes in the knee joint were evaluated with US, and the presence or absence of JLT was evaluated using a pressure algometer. Logistic regression analysis was performed to evaluate the odds ratios (ORs) of US findings for the presence of JLT. Moreover, when the analysis was limited to knees with pre-/early radiographic KOA, the ORs were also calculated using logistic regression analysis. Among the 242 knees, 38 had medial JLT, which was significantly associated with female sex (OR 11.87) and loss of cartilage thickness of the distal medial femoral condyle (CTh-MFC) (OR 0.12). Among 96 knees with Kellgren-Lawrence grade ≤ 2, 18 knees had medial JLT, which was also significantly associated with loss of CTh-MFC (OR 0.07) and medial osteophytes (OR 2.01). JLT is significantly associated with thinning of the femoral cartilage and larger osteophytes in elderly patients, even in those with pre-/early radiographic KOA.

Annals for Educators - 20 October 2020

Annals for Educators - 20 October 2020

Atraumatic Knee Swelling - Runner

HISTORY: 38-year-old male runner with 4 months of left knee pain and swelling that he noticed worsened with running. He remembers no particular injury, increase in mileage, change in footwear, or systemic symptoms such as night sweats, weight loss, or other joint swelling. He was seen in urgent care with his exam showing an effusion and painful range of motion. He was diagnosed with a knee sprain, MRI ordered, and referred to sports medicine. In our clinic, he complained about anterolateral knee pain, persistent knee effusion, and inability to train because of pain and swelling. He denied locking or giving way. PHYSICAL EXAMINATION: Left knee with 1-2+ non-warm effusion, range of motion 0-130 degrees, lateral patellar facet tenderness, medial joint line tenderness, Lachman negative, valgus/varus testing stable, McMurray negative for click. DIFFERENTIAL DIAGNOSIS: 1. Medial meniscal tear 2. Patellar chondromalacia 3. Rheumatologic disorder 4. Pigmented nodular synovitis 5. Synovial chondromatosis TEST AND RESULTS: X-ray: small joint effusionMRI without contrast: large joint effusion, small medial meniscal tear, lateral patellar facet chondromalaciaArthrocentesis: 303,500 RBCs, 839 WBCs, no crystals; ESR 10, CRP 0.08, ANA negative, RF negative, Normal CBC; MRI with contrast: multiple round lesions on the medial posterior mid joint next to the proximal tibiofibular joint with peripheral enhancement consistent with pigmented villonodular synovitis vs infection FINAL WORKING DIAGNOSIS: 1. Pigmented villonodular synovitis 2. Medial meniscal tear 3. Patellar chondromalacia TREATMENT AND OUTCOMES: 1. Athlete was initially treated with physical therapy for the atraumatic meniscal tear. 2. Athlete had persistent effusion, with an aspiration that showed blood. This provoked review of prior MRI with concern of nodularity of synovium. Therefore an MRI with contrast was performed consistent with likely pigmented nodular synovitis. 3. Athlete evaluated by orthopedics for arthroscopy and synovial biopsy. Intraoperative findings included diffuse involvement of joint including anterior compartment, medial and lateral gutters, and the notch. Pathology consistent with pigmented villonodular synovitis. 4. Post op care complicated by poor progression of range of motion, current 10 to 70 degrees.

Do Clinical Correlates of Knee Osteoarthritis Predict Outcome of Intraarticular Steroid Injections?

To determine whether clinical correlates of knee osteoarthritis (OA) affect the outcome of intraarticular steroid injections (IASI) in symptomatic knee OA. Men and women aged ≥ 40 years with painful knee OA who participated in an open-label trial of IASI completed questionnaires and clinical examination. The Outcome Measures in Rheumatology (OMERACT)-Osteoarthritis Research Society International (OARSI) criteria were used to assess response to therapy in the short term (within 2 weeks). Among those who initially responded, those whose pain had not returned to within 20% of the baseline Knee Injury and Osteoarthritis Outcome Score pain score at 6 months were characterized as longer-term responders. Log-binomial regression was used to examine factors associated with outcome. One hundred ninety-nine participants were included, of whom 146 (73.4%) were short-term and 40 (20.1%) longer-term responders. Compared to short-term nonresponders, participants with these characteristics were more likely to be short-term responders: medial joint line tenderness [relative risk (RR) 1.42, 95% CI 1.10-1.82], medial and lateral joint line tenderness (RR 1.38, 95% CI 1.03-1.84), patellofemoral tenderness (RR 1.27, 95% CI 1.04-1.55), anserine tenderness (RR 1.27, 95% CI 1.06-1.52), and a belief that treatment would be effective [RR/unit increase (range 0-10) = 1.05 (1.01-1.09)]. Aspiration of joint fluid (RR 0.79, 95% CI 0.66-0.95) and previous ligament/meniscus injury (RR 0.63, 95% CI 0.44-0.91) were associated with a reduced risk of being a short-term responder. Compared to initial nonresponders and those whose pain recurred within 6 months, participants with a higher number of pain sites [RR/unit increase (range 0-10) = 0.83, 95% CI 0.72-0.97], chronic widespread pain (RR 0.32, 95% CI 0.10-0.98), perceived chronicity of disease [RR/unit increase (range 0-10) = 0.86, 95% CI 0.78-0.94], and a higher depression score [RR/unit increase (range 0-21) = 0.89, 95% CI 0.81-0.99] were less likely to be longer-term responders. Among patients with symptomatic knee OA, tenderness around the knee was associated with better short-term outcome of IASI. However, clinical-related factors did not predict longer-term response, while those with chronic widespread pain and depressive symptoms were less likely to obtain longer-term benefits.

Diagnostic Validity of Combining History Elements and Physical Examination Tests for Traumatic and Degenerative Symptomatic Meniscal Tears

BackgroundThe current approach to the clinical diagnosis of traumatic and degenerative symptomatic meniscal tears (SMTs) proposes combining history elements and physical examination tests without systematic prescription of imaging investigations, yet the evidence to support this diagnostic approach is scarce. ObjectiveTo assess the validity of diagnostic clusters combining history elements and physical examination tests to diagnose or exclude traumatic and degenerative SMT compared with other knee disorders. DesignProspective diagnostic accuracy study. SettingsPatients were recruited from 2 orthopedic clinics, 2 family medicine clinics, and from a university community. PatientsA total of 279 consecutive patients who underwent consultation for a new knee complaint. MethodsEach patient was assessed independently by 2 evaluators. History elements and standardized physical examination tests performed by a physiotherapist were compared with the reference standard: an expert physicians’ composite diagnosis including a clinical examination and confirmatory magnetic resonance imaging. Participating expert physicians were orthopedic surgeons (n = 3) or sport medicine physicians (n = 2). Penalized logistic regression (least absolute shrinkage and selection operator) was used to identify history elements and physical examination tests associated with the diagnosis of SMT and recursive partitioning was used to develop diagnostic clusters. Main Outcome MeasuresDiagnostic accuracy measures were calculated including sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios (LR+/–) with associated 95% confidence intervals (CIs). ResultsEighty patients had a diagnosis of SMT (28.7%), including 35 traumatic tears and 45 degenerative tears. The combination a history of trauma during a pivot, medial knee pain location, and a positive medial joint line tenderness test was able to diagnose (LR+ = 8.9; 95% CI 6.1-13.1) or exclude (LR– = 0.10; 95% CI 0.03-0.28) a traumatic SMT. Combining a history of progressive onset of pain, medial knee pain location, pain while pivoting, absence of valgus or varus knee misalignment, or full passive knee flexion was able to moderately diagnose (LR+ = 6.4; 95% CI 4.0-10.4) or exclude (LR– = 0.10; 95% CI 0.03-0.31) a degenerative SMT. Internal validation estimates were slightly lower for all clusters but demonstrated positive LR superior to 5 and negative LR inferior to 0.2 indicating moderate shift in posttest probability. ConclusionDiagnostic clusters combining history elements and physical examination tests can support the differential diagnosis of SMT. These results represent the initial derivation of the clusters and external validation is mandatory. Level of EvidenceI

Relationship between Clinical, MRI, and Arthroscopic Findings: A Guide to Correct Diagnosis of Meniscal Tears.

Purpose The aim of this prospective study was to compare and correlate clinical, MRI, and arthroscopic findings in cases of suspected meniscal tears. Using arthroscopic findings as the gold standard, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of clinical investigation and MRI were evaluated to determine if is possible, after a careful examination, to bypass MRI and perform directly arthroscopy in suspected cases. Methods A total of 80 patients with a history of knee trauma, preoperative RX, and MRI underwent arthroscopy over an 8-month period at our department. All patients had a clinical examination performed by an experienced knee surgeon. These examiners evaluated and recorded the results of three tests: medial and lateral joint line tenderness test, McMurray's test, and Apley's test. The injury was classified as a meniscal tear if there were at least two positive tests. Finally, using the arthroscopic findings as the gold standard, sensibility, specificity, accuracy, positive and negative predictive values of clinical examination, and MRI were evaluated and compared. Results Clinical examination performed by an experienced knee surgeon reported better sensitivity (91 vs. 85%), specificity (87 vs. 75%), accuracy (90 vs. 82%), positive predictive value (94 vs. 88%), and negative predictive value (81 vs. 71%) than MRI for medial meniscal tears. These parameters showed minimal differences for lateral meniscal tears. Conclusion Clinical examination performed by an experienced knee surgeon provided equal or better results to diagnose meniscal injuries in comparison to MRI. MRI is not necessary to confirm these lesions and should not be used as the primary diagnostic tool. Level of Evidence Level II, prospective study.

McMurray's Test and Joint Line Tenderness for Medial Meniscus Tear: Are They Accurate?

Meniscus tears are the most common injury of the knee. The McMurray's test and Joint line tenderness for diagnosing meniscus tear have been widely tested, but results reported by different authors vary. The wide variations reported have an impact on clinical decision concerning whether to go for other diagnostic tests before going for diagnostic arthroscopy, which is considered as the gold standard.The purpose of this study was to determine the diagnostic value of Joint line tenderness and McMurray's test, as clinical signs, to diagnose underlying medial meniscus tears. This was a prospective observational study done in Tribhuwan University Teaching Hospital. Patients undergoing knee arthroscopy were included in the study period of one year (from February 2011 to January 2012). Each patient was clinically examined with McMurray's test and joint line tenderness. The findings were then matched by the arthroscopic findings. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were then calculated. The sensitivity, specificity, positive predictive value , negative predictive value and accuracy for medial joint line tenderness in diagnosing medial meniscus tear were 50%, 61.7%, 51.8%, 60% and 56.45% respectively. The result was insignificant (p value=0.352). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy for McMurray's test for diagnosing medial meniscus tear were 54%, 79%, 68% , 67.50% and 67.74% respectively. The result was significant (p value=0.007). Clinical tests like McMurray and joint line tenderness have low diagnostic value when applied individually. They may be useful when combined together with the background of clinical history. The decision to scope the knee should not be solely taken on the results of clinical tests.

Gender differences in the accuracy of joint line tenderness for arthroscopically confirmed meniscal tears.

The reliability of joint line tenderness was previously investigated among other clinical tests for the diagnosis of meniscal pathology with variable results. The aim of this study was to evaluate and compare the accuracy of joint line tenderness as a clinical diagnosing test for arthroscopically confirmed meniscal tears between males and females. For the purpose of preoperative joint line tenderness accuracy calculations, this study included male and female groups of patients who have had knee arthroscopy following preoperative diagnosis of meniscal tear. Overall, 195 patients were included in the study, 134 males and 61 females. The mean age was 43.4 (13-76) years. In the male group, the diagnosis of meniscal tear by joint line tenderness was correct in 84 (62.7%) of 134 knees for the medial side and in 115 (85.8%) for the lateral side. In the female group, the diagnosis was correct in 35 (57.4%) of 61 knees for the medial side and in 57 (93.4%) for the lateral side. In order to refine the accuracy of medial joint line tenderness, the data were recalculated for patients with medial meniscal tears and no chondral lesion or cruciate ligament tears; however, the accuracy remained low. The physical finding of joint line tenderness of the knee as a test for lateral meniscal tear was found reliable in both males and females. For medial meniscal tears, the test had low reliability and thus less useful if used alone, in both genders.

Clinical Evaluation of the Root Tear of the Posterior Horn of the Medial Meniscus in Total Knee Arthroplasty for Osteoarthritis.

PurposeTo investigate the incidence of root tears of the posterior horn of the medial meniscus in total knee replacement arthroplasty for knee osteoarthritis and retrospectively analyze clinical results and factors associated with root tears.Materials and MethodsThere were 197 knees of 140 enrolled patients who had undergone total knee replacement arthroplasty between September 2010 and May 2014. The presence of a root tear of the posterior horn of the medial meniscus was confirmed in all patients. Statistical analysis was performed to investigate the correlation between root tears and the possible factors of meniscal tears including gender, age, severity of symptoms (visual analogue scale [VAS] score and medial joint line tenderness), grade of osteoarthritis (Kellgren-Lawrence grading scale), body mass index (BMI), varus deformity, and mechanical axis deviation.ResultsMeniscal tears were observed in 154 knees (78.17%). The root tear had correlation with the severity of osteoarthritis (p<0.05), varus deformity (p<0.05), mechanical axis deviation (p<0.05), and BMI (p<0.05).ConclusionsFactors considered to represent the severity of osteoarthritis were found to be associated with root tears of the medial meniscus posterior horn. Increased BMI seemed to be associated with the increased incidence of root tears of the medial meniscus posterior horn.

Pathognomic Discoid Medial Meniscus with a Parameniscal Cyst: A Case Report and Literature Review of Anomalous Medial Meniscus Variants

Discoid medial meniscus is an extremely rare anomaly with an incidence of 0.1-0.3%. Only 35 cases have been reported in literature so far. The association of a Parameniscal cyst with a discoid medial meniscus has been not described in literature to our knowledge. The cyst related to the discoid medial meniscus was anteromedial in location as compared to the lateral discoid meniscus cyst which usually is in lateral or postero-lateral in position. We present a case report of a complete discoid medial meniscus with a parameniscal cyst which was treated successfully by excision of the central anomalous part of the meniscus and cyst decompression. The presentation differs drastically as compared to a discoid lateral meniscus and the age of presentation is also not defined due to rarity of such cases. The discoid medial meniscus developed a horizontal cleavage tear and consequently a parameniscal cyst which became symptomatic insidiously. Physical examination revealed medial joint line tenderness with Thessaly test and Steinman II tests positive (Figure 1). Controversy exists with regards to the etiology of discoid medial meniscus wherein Kaplan in 1974 stated that congenital alteration in the attachment of posterior horn of the meniscus by the meniscofemoral ligament which becomes hypermobile and Smillie postulated that menisci exist as cartilaginous disc at an early stage in development and congenital discoid meniscus is attributable to persistence of the disc shape at varying stages of embryonic development. Various anomalies reported include anterior horn hypoplasia, anomalous posterior horn attachment to lateral femoral condyle, anomalous insertion of anterior horn to ACL, anterior transportation of the anterior medial meniscus below the anterior edge of the tibial plateau and the anterior horn contiguous with the ACL, increased tibial plateau concavity with elongated medial tibial spine and lastly bilateral occurance.

Cost-effectiveness Analysis of the Diagnosis of Meniscus Tears

These are the MRI scans of a 58-year-old female, who was seen in an orthopaedic sports medicine clinic with complaints of medial knee pain after an increase in squatting forms of exercise. In addition she notes mechanical symptoms and pain with lateral and twisting movements. Physical examination revealed a small effusion, a negative Lachman test, medial joint line tenderness and a positive McMurray’s test. The MRI shows a medial meniscus tear of the right knee. The MRI also shows degeneration of the lateral meniscus posterior horn. History and physical examination (H&P) has good accuracy for the diagnosis of meniscus tears of the knee. For all degenerative types of tears, H&P alone without MRI is the preferred, cost effective diagnostic strategy. However, there is a role for the use of an MRI in addition to H&P in diagnosing traumatic meniscus tears in younger patients. While MRIs may aid in the diagnostic process and might even be considered the gold standard, alternative strategies that eliminate MRI use may decrease both health care costs and the number of unnecessary procedures without compromising patient safety (Figure 1).

Results of Meniscus Repair for the Hypermobile Medial Meniscus

Objectives:There have been very few studies on hypermobile lateral meniscus, but hypermobility of the medial meniscus has not been reported; the latter is more common in our practice. It is characterized by lax peripheral attachment of the middle 1/3 of the medial meniscus without a tear existing. In its most severe form (grade III) the meniscus can be displaced to the middle of the plateau and everted more than 60 degrees by probing the meniscocapsular attachment. The purpose of the present study is to analyse the clinical features of hypermobile medial meniscus and the results of meniscus repair.Methods:14 patients (14 knees; 10 right) underwent arthroscopic meniscal repair for hypermobile medial meniscus. Men and women were equally affected; average age was 28 (14-46). The mean duration of symptoms was 18 (2-96) months. Six cases (43 %) had no history of trauma. The most common symptoms were medial joint line pain (n:14), locking (n:9), giving way (n:9), rest pain (n:9) and inability to squat (n:5). The most common clinical findings were medial joint line tenderness (n:11), positive McMurray’s test (n:9), medial retinacular tenderness (n:6), and effusion (n:3). 13 patients were rated as poor by the Lysholm scale; average 52(35-85), average Tegner activity level was 5.6 (3-9). MRI, available for eight patients, did not show any spesific findings. Arthroscopy did not reveal any other lesions to explain the mechanical symptoms. SPSS 16,00 for Windows (Statistical Program for the Social Services Inc, Chicago, IL, USA) program was used for statistical analysis. Continuous variables were defined as mean ± standard derivation. Variables were tested for normal distribution by using the Kolmogorov–Smirnow test. Differences between the groups were assessed by using unpaired t-test or Mann–Whitney U-test instead, if continuous variables did not have normal distribution. Paired sample t-test was used to compare continuous variables (data of Tegner and Lysholm scores, preoperative and at last control). P < 0.05 was accepted as statistically significant.Results:All the patients were available for follow-up; average 32 (6-59) months. 11 patients (78 %) had no mechanical symptoms. Patients’ own evaluation was; 3 very good, 7 good, 3 fair and 1 poor. 13 patients were better. At follow-up, significant improvement was obtained in Lysholm score which was 84(52-100) in average (p<0.01) ; 9 (64 %) good-excellent,4 (28%) fair and 1 (7%) poor. Tegner levels were almost regained: Decrease by 1 grade (4.7 in average (1-9)) (p=0.026). Despite satisfactory results, more than half had minor symptoms and findings.Conclusion:Hypermobile medial meniscus is characterized by medial pain and mechanical symptoms. Two types can be distinguished: traumatic and atraumatic. For significant hypermobility, the meniscus should be stabilized by repair. Patients benefit from repair, but more than half continue to have minor symptoms.

Discoid Medial Meniscus Completely Coalesced With the Anterior Cruciate Ligament

Discoid meniscus is an abnormality of the knee in which the meniscus is discoid rather than semilunar in shape. Medial discoid menisci are rare, and no specific associated symptoms suggest this condition. Several medial meniscus anomalies, including discoid variants, have been reported in the literature. This article describes a rare case of medial discoid meniscus completely coalesced with the anterior cruciate ligament (ACL). A 22-year-old man presented with intermittent right knee pain of 6 months' duration. Physical examination revealed mild wasting of the quadriceps with medial joint line tenderness but no effusion. Radiographically, hypoplasia of the lateral tibial spine, increased medial joint space, and increased concavity of the medial tibial condyle were noted in both knees. Arthroscopic examination revealed a complete discoid medial meniscus that was contiguous with the ACL. On probing, a horizontal tear in the medial meniscus was noted. A meniscectomy was performed, and deep longitudinal furrows with exposed subchondral bone were noted underlying the posteromedial tibial condyle. At the patient's 6-month follow-up visit, he had no knee symptoms and had returned to his daily activities, which included jogging. Discoid medial meniscus is a rare anomaly, and this case represents only the second reported in the literature of discoid medial meniscus completely coalesced with ACL. This case supports the theory that the ACL and menisci can be differentiated from 1 mesenchyme.