Meniscal tear

Differential diagnosis

Differential Diagnosis table forMeniscal tear
ConditionDifferentiating signs/symptomsDifferentiating tests
Anterior cruciate ligament tear
  • Subluxation on twisting, turning, or pivoting; some patients can feel this coming on, while other patients are not able to feel it and may experience frequent falls due to their injury.

  • Positive Lachman's test, anterior drawer test, and pivot shift test on physical examination.

  • MRI scan reveals ruptured anterior cruciate ligament (ACL) and disruption of ACL fibres, usually associated with bone bruising in acute setting.

Medial collateral ligament sprain
  • True dynamic instability is rare, unless it is a complete tear or associated with other injuries. Tenderness over medial collateral ligament (MCL) course/insertion may be present. MCL stress testing reveals laxity and/or pain.

  • MRI scan reveals fluid around or injury to MCL and differentiates between an isolated MCL injury and one combined with a meniscal tear.

  • Subsequent x-rays may reveal calcification along previously injured MCL (Pellegrini-Stieda's disease).

Posterior cruciate ligament sprain
  • Patient is often able to continue activity but notes that the knee does not feel right.

  • Instability may be more subtle, with knee effusion typically small and less noticeable. In addition, the posterior drawer test is positive.

  • MRI scan reveals disrupted posterior cruciate ligament and intact menisci.

Lateral collateral ligament sprain
  • Local swelling is common, but significant effusion is rare. There is tenderness over the lateral collateral ligament (LCL) and/or bony insertion.

  • A complete tear often results in a palpable gap. [18]

  • MRI reveals fluid around or disruption to the LCL and differentiates between an isolated LCL and one combined with a meniscal tear.

Osteochondritis dissecans
  • A joint condition in which some parts of the joint cartilage and bone lose their blood supply due to an unknown aetiology, and may detach from the joint surface. Adolescents are commonly affected. May present with knee pain and swelling. Catching of the knee can occur, especially during or after sporting activity.

  • X-ray or MRI scan of the affected knee will reveal the osteochondral lesion. MRI can be of particular use in detecting the early phase of the condition.

Osteochondral fracture
  • Caused by a twisted knee, usually occurring during sporting activity. Presents with knee pain, swelling, and catching. The osteochondral fragment is detached. The medial femoral condyle is frequently involved.

  • X-rays or other advanced imaging including CT scan or MRI may demonstrate the osteochondral fragment.

Medial synovial plica syndrome
  • The synovial fold on the medial side of the knee is called the medial plica. This stucture is sometimes exposed to direct injury or impingement between the patella and medial femoral condyle. It may also be injured in overuse syndromes. The injured medial plica causes irritation and inflammation of the knee presenting with knee swelling and pain usually in a medial distribution, although can involve the superior or lateral aspect of the knee.

  • MRI scan usually confirms the diagnosis. However, arthroscopy may be necessary.

Last updated: May 20, 2013
Top

Use of this content is subject to our disclaimer