When a jump ball goes wrong

 

Case: 32-year-old basketball player

Reason for visit: Twisted right knee while playing basketball two days ago. Now has an achy pain in his right knee and some swelling.

After physical exam and appropriate imaging, he was found to have a torn meniscus.

What is a meniscus? What is its function?

A meniscus is a “C” shaped piece of fibrocartilage found in the knee. Each knee has both a medial and lateral meniscus. The meniscus serves to disperse the load over the entire joint. Much of its function is reliant on tensile strength. A tear can compromise the tensile strength of the meniscus and in turn impede its function.

What are the symptoms of a torn meniscus?

A torn meniscus can present with knee popping or locking. The patient may complain that knee feels like it can give out at any second. Patients will also complain of tenderness over the joint line and an impaired ability to squat down. Some patients will also exhibit joint swelling.

Management

Physical exam and imaging are used to make the diagnosis. An x-ray of the knee is often performed to rule out any injury to the bone. An MRI is used to determine the presence of a tear, the location of the tear, the length of the tear, and the pattern. These factors are very important in determining likelihood of the tear healing and greatly impact the management of the injury. Conservative management involves rest, ice, anti-inflammatory medications, bracing, activity modification, and physical therapy. Surgery can involve repair of the tear or removal of the torn section of the meniscus (partial meniscectomy).

Importance of prognostic factors

The meniscus is can be divided into three zones based on blood flow. The red-red zone has the highest blood flood and thus has the highest likelihood of healing. The red-white zone is an intermediate zone. The white-white zone has the lowest blood flow meaning that injuries in this zone are less likely to heal. Tear length is important because the longer tears are less likely to heal. The pattern of tear is also important in determining prognosis. For example, longitudinal tears are more likely to heal than horizontal or bucket handle lesions.

If you think you are suffering from a torn meniscus or have more questions about it call Scottsdale Sport Medicine Institute to schedule an appointment with Dr. David Carfagno.

Dr. David Carfagno is a Board Certified Internist and Sports Physician, who trained at the Cleveland Clinic Foundation

Śmigielski, R., Becker, R., Zdanowicz, U., & Ciszek, B. (2014). Medial meniscus anatomy—from basic science to treatment. Knee Surgery, Sports Traumatology, Arthroscopy Knee Surg Sports Traumatol Arthrosc, 8-14.

Yim, J., Seon, J., Song, E., Choi, J., Kim, M., Lee, K., & Seo, H. (2013). A Comparative Study of Meniscectomy and Nonoperative Treatment for Degenerative Horizontal Tears of the Medial Meniscus. The American Journal of Sports Medicine, 1565-1570.