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Case Study: Acute Knee Injury

A 31 year old male presented to physiotherapy following an acute knee injury at soccer training the previous day. The injury occurred whilst the patient was sliding in to tackle an opponent, the patient felt that direct contact was made with the knee but could not remember if the knee was twisted, or if it was planted on the ground at the time, he denied hearing a pop or crack and has not had any clicking locking or giving way.

The knee was moderately swollen. Passive extension was extremely painful and passive flexion was mildly painful, there was pain on palpation of the posteromedial joint line. Ligaments testing of the ACL, PCL, MCL and LCL revealed no pain or laxity. McMurray’s test caused pain 8/10 without any clicking. A provisional diagnosis of a medial meniscal tear was made.

 

Because the patient was unable to fully extend the knee and a meniscus tear was suspected, the patient was referred to their GP who then referred the patient for an MRI under item number 63560. MRI confirmed the findings of a medial meniscus tear, a flap tear of the posterior third of the medial meniscus.

 

The patient was counseled on the likelihood the tear would not heal and the option of referral to an orthopaedic surgeon. However the patient wanted to try a conservative approach first.

 

Physiotherapy treatment included soft tissue massage and ultrasound to decrease pain and swelling, as well as quadriceps strength and control exercises. At 2 weeks full pain free range of motion with full resolution of swelling was achieved. A return to sport program then commenced and full successful return to soccer was achieved at 8 weeks.

 

  • Acute meniscus tears are common amongst the sporting population
  • They are usually the result of a twisting force on a planted foot
  • The most common area for a tear is the posterior horn
  • Classic signs: Joint line tenderness, effusion, clicking, and locking.
  • Most common clinical test is McMurray’s: This involves internal and external rotation of the tibia on the femur while flexing and extending the knee (pictured left). Positive test = reproduction of pain and may cause clicking.
  • MRI is >95% sensitive for detecting meniscus tears.
  • Item 63560 now gives a medicare rebate for MRI referrals from GPs when extension is limited and meniscus is the expected cause.
  • Most meniscus tears will not heal without intervention, however in some cases conservative management does allow resumption of desired activities without a return of symptoms.

 

 

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