Essential Surgery: Problems, Diagnosis and Management, Third Edition


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Thessaly test: The clinician holds the patient's outstretched hands for support, while the patient stands flat-footed with their knee flexed to 20 degrees and rotates their body and knee three times, internally and externally. The test is positive if symptoms are reproduced on rotation Nonoperative treatments are an important part of the management of all patients, regardless of whether surgery is being considered.


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Immediate conservative measures include the RICE regimen:. Longer term measures include activity modification, nonsteroidal antiinflammatory drugs NSAIDs and physiotherapy. Physiotherapy at two visits per week for at least 8 weeks is recommended. Nonoperative treatments are often successful in patients with certain types of tear — patients who have no loss of joint function, suffer minimal pain or swelling and are willing to reduce their activities — temporarily or in the long term.

Patients are often aware of movements that aggravate mensical pain, but should also be educated to avoid twisting on a weight bearing, flexed knee. Surgical treatment is usually reserved for younger patients with a vertical longitudinal tear within the vascularised outer third of the meniscus. This is termed the 'red-red zone' denoting area of vascularity. Damaged avascular meniscus must be removed. For patients requiring meniscectomy, meniscal autograft has been utilised with good outcomes, 29—31 but is only performed in specialist centres.

Research is currently investigating the possibility of implantation of collagen, allogenic and xenogenic cells, embryonic and adult stem cells, or scaffolds derived from polymers, hydrogels, tissues and extracellular matrix, 7 and action of biological stimuli eg. Figure 4. Proton weighted sagittal image demonstrates an example of a posterior horn medial meniscal horizontal tear white arrow.

The anterior horn of the medial meniscus demonstrates half of the normal anatomic 'bow-tie configuration'. Note: the cartilage deficit more anteriorly on the medial femoral condyle and altered subchondral cortical bone interface. Figure 5. Coronal proton weighted MRI of horizontal tear of lateral meniscus white arrow with complicating ganglion black arrow at the lateral margin of the meniscus.

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Hands, fingers, thumbs Assessment and management of common hand injuries in general practice. Feeding in the first year of life Emerging benefits of introducing complementary solids from 4 months. Fitness to drive GP perspectives of assessing older and functionally impaired patients. Patients and tests A study into patient understanding of blood tests ordered by their doctor.

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Focus Injuries. Meniscal tear Presentation, diagnosis and management Volume 41, No. Article Download article Download Citations. Tim Shiraev Suzanne E Anderson Nigel Hope Background Medial and lateral knee joint menisci serve to transfer load and absorb shock, aid joint stability and provide lubrication. Discussion Magnetic resonance imaging can confirm clinical concern for meniscal tear, review intra- and extra-articular anatomical structures and exclude alternative diagnoses.

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I declare the following competing interests:. Yes No. Confirm E-mail:. Add Another Author. Competing Interests:. A hazardous life Our role in injury prevention. Letters to the editor. Sprains and strains. Maxillofacial trauma. Meniscal tear Presentation, diagnosis and management.

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