Meniscus Tear

Meniscus Tear

Meniscus tear header

Body Chart

Meniscus tear pain diagram
  • At height of the joint line (medial or lateral)

Background Information

Patient Profile

  • Acute injury rather in young people engaging in sports
  • Degenerative tears in older people without trauma in history


Acute: Hyperextension trauma or flexion-rotation-trauma under load (sports, work, ADL)

Degenerative changes over the years and repetitive normal movement without trauma


Acute: Pain- and tissue healing mechanisms align
Inflammation phase: Dominant inflammatory nociceptive: signs of inflammation, night pain, pulsating, immobilization leads to stiffness, sometimes increases with rest

Proliferation phase: Dominant mechanical nociceptive: clear on/off behavior, load dependent pain, local, decreases with rest


Chronic: Pain- and tissue healing mechanisms do not align
Dominant mechanical nociceptive: clear on/off behavior, load dependent pain, local, decreases with rest



Acute: Pain is movement dependent – Flexion/extensionChronic: Under increasing load – Compression & shear forces

Acute: Rest, icingChronic: Reduce activities, avoid overload & shear forces

24 Hour
Acute: Night pain due to local inflammation
Chronic: More pain at night, possible intraarticular swelling

History & Physical Examination


History of knee trauma; knee exposed to high loads in work, sport, ADL Usually trauma; older patients also inadequate trauma (degenerative tear)

  • “Giving way” possible but not main symptom
  • Typically no feeling of instability
  • Acute: Locking in Flex/Ext, limited ROM, local pain, stinging, deep
  • Chronic: Degeneration pain, “cracking” or “popping”, dull pain


Physical Examination

InspectionAcute: Signs of inflammation medial side, possible hemarthrosis, intraarticular swelling, protective postureChronic: Quadriceps/gastrocnemius atrophy, barely any swelling

Functional AssessmentAcute: not possible due to symptomsChronic: Deep squat, climbing stairs, cutting motion, “giving way” rather described than demonstrated

Active ExaminationAcute: limited ROM in Flex/Ext/Rot and pain upon small loadChronic: end of range limitation in Flex/Ext; high loads in combination with these movements is painful. Balance problems – single leg stance, step-up

Passive ExaminationAcute: PROM limited, swellingChronic: End or range ROM can be limited, structural instability apparent

Special Testing

Differential Diagnosis

  1. Subchondral injury
  2. Damaged cartilage
  3. Gonarthrosis
  4. Avulsion fracture biceps femoris
  5. Tibial plateau fracture
  6. Unhappy triad
  7. Pes anserinus irritation
  8. Patella luxation
  9. PFPS
  10. Quadriceps tendon rupture
  11. Patella tendon rupture
  12. Osgood Schlatter



Conservative: coper, isolated injury, >45 years old, linear sportsSurgical: non-coper, multidirectional injury, <45 years old, high risk sports



Post-OP: Adapt interventions/load to tissue healing phasesConservative: Identify deficits in strength, neuromuscular control, passive structuresPrinciples: concentric before eccentric, slow to fast, low load + high rep to high load + low rep, two-legged to one-legged, pay attention to sport specific demands


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