The knee is the largest weight bearing joint in the body. It is comprised of the largest bone in the body, the femur, bearing down on the tibia plateau. The meniscus cushions the joint between the bones. Often times when there is force exerted on the leg in an accident directing the tibia in the direction of the femur or vice versa, such force causes insult to the knee.
When this occurs there can be traumatically induced tearing to the meniscus. In order to ascertain whether or not an anatomical change has occurred in the meniscus, one needs to take a full history, conduct a thorough physical examination, and obtain radiographic studies of the area. In diagnosing a traumatically induced maniacal injury, a complete history is very important. All too often a diagnostician perceives conclusions before completing the steps necessary to make the diagnosis.
One of the most important steps in determining the outcome of a leg trauma is to ask the patient those key questions needed to bring these injuries to light. Not only do patients need to ask about the nature and location of the pain, they ought to be asked about the details of the mechanism of the injury. An understanding of the forces imposed on the knee or leg which brings that patient before the diagnostician can reveal the existence of an injurious mechanism to the meniscus that may otherwise be overlooked and lead the diagnostician to leave out meniscal injury as part of their differential diagnosis.
Once a complete history is obtained and documented, a thorough examination including, but not limited to, of range of motion, palpation, asking about mid-line pain, listening for crepitus, conducting a McMurry, and looking closely at the knee for visible bruising or lacerations ought to be performed. These tests will provide the diagnostician with more of the information necessary to ascertain the patient’s pain generator. The examiner then needs to document the findings as accurately as possible in order for the orthopedist to have all of the data necessary to clinically correlate the examiner’s findings with the radiographic studies which will need to be performed before recommending arthroscopic surgical intervention.
At this juncture, the patient is to undergo an MRI study in order rule out meniscus tearing. If the radiologist or the orthopedist do not observe tearing on the study and the patient continues to have the same complaints after physical therapy treatment or continues to experience pain over a long period of time, then consider a follow up MRI or an MR Arthrogram to go back and re-confirm the original findings or reveal those findings which may not have appeared in the first study as patients who have knee pain of an unknown etiology over a long period of time are likely suffering from some form of an anatomical change. A good diagnostician is one who is willing to continue to consider differential diagnoses as well as reconsider once ruled out diagnoses.