The Medscape article on meniscus injuries, although designed for physicians, is an excellent resource for patient decision-makers. The author is Bradley S. Baker, MD, a clinical professor at the Department of Orthopedic Surgery and Sports medicine at Sanford School of Medicine, University of South Dakota.
The article is available at: https://emedicine.medscape.com/article/90661-overview.
The differential diagnosis of knee pain (a fancy way of saying other possible causes that you think might be due to a meniscal injury) is easy to access on the medscape site at: https://emedicine.medscape.com/article/90661-differential. From this page you can access excellent articles on each of possible causes in the list.
So, using the fancy term, the differential diagnosis (the other possibilities) of knee pain thought to be due to meniscus injury is: “anterior cruciate ligament injury, contusions, iliotibial band syndrome, knee osteochondritis dessicans, lateral collateral knee ligament injury, lumbosacral radiculopathy, medial collateral knee ligament injury, medial synovial plica irritation, patellofemoral joint syndrome, pes anserina bursitis, [and] posterior cruciate ligament injury”.
The first study ordered when a meniscus tear is suspected are knee x-rays to look for fractures. X-rays, however, do not show injuries to the soft tissues of the knee (all the problems listed above in differential diagnosis). If soft tissue damage is suspected, then an MRI of the knee is ordered.
The imaging guidelines for the evaluation of acute knee injury are outstandingly detailed the American College of Radiology Appropriateness Criteria for Acute Knee Injury which is available at
https://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/pdf/ExpertPanelonMusculoskeletalImaging/AcuteTraumatotheKneeDoc2.aspx.
The evidence tables for the above imaging recommendations are also excellent and worth reviewing at
https://www.acr.org/acet/Acute-Trauma-to-the-Knee-ET.pdf.
The medscape article discussing meniscus injury treatment recommends (depending on patient’s age, activity level, the type of meniscus injury, and the presence of associated injuries) that “A trial of conservative treatment should be attempted in all but the most severe cases, such as a locked knee secondary to a displaced bucket-handle tear.” The recommendation is made at https://emedicine.medscape.com/article/90661-treatment
The article further recommends that “If symptoms persist, if the patient cannot risk the delay of a potentially unsuccessful period of observation (eg, elite athletes), or in cases of a locked knee, surgical treatment is indicated.”
The medscape recommendations for surgical treatment are also available at https://emedicine.medscape.com/article/90661-treatment.
The most important surgical principle is to save the meniscus. Meniscal tears that have a good probability of healing should be repaired. However, most tears can’t repaired and the surgeon tries to resect as little of the meniscus as possible (tries to perform a partial menisectomy).
