MANUAL MINORS
Posterior horn meniscus tears (medial and lateral) occur in the rear part of the menisci, which are cartilaginous structures that act as shock absorbers between the femur and tibia in the knee joint.
These injuries are common in athletes and individuals who perform repetitive twisting or knee flexion movements, but they may also be associated with meniscal degeneration in older adults. The medial meniscus is more frequently affected than the lateral due to its reduced mobility.
Diagnosis
Patients often report pain in the posterior or lateral part of the knee, which may worsen with deep knee flexion or rotational movements. There may be knee locking or clicking sensations, as well as a feeling of instability.
The diagnosis is clinically suspected through physical examination, using tests like McMurray’s or Apley’s, which reproduce the pain or symptoms. However, definitive confirmation is obtained via magnetic resonance imaging (MRI), the preferred method to visualise meniscal tears, their location, and their extent.
Differential Diagnosis
Condition | Key Differentiation |
|---|---|
Anterior Cruciate Ligament (ACL) Injury | Anterior knee instability, with specific tests like Lachman or Pivot-shift positive. |
Medial Collateral Ligament (MCL) Injury | Localised pain on the medial side of the knee, without joint locking. |
Anterior Horn Meniscus Tear | Pain in the anterior knee, without posterior involvement. |
Chondromalacia Patella | Pain in the anterior knee, worsened by deep flexion. |
Knee Osteoarthritis | Chronic pain associated with stiffness and crepitus, with degenerative findings on X-rays. |
Emergency Management
Initial management of a posterior horn meniscus tear includes rest, ice, compression, and elevation (RICE), along with analgesics (NSAIDs). If the patient has severe joint locking or incapacitating pain, temporary knee immobilisation may be required until further evaluation. Initial physiotherapy to reduce pain and restore mobility can begin after a detailed assessment.
Definitive Treatment
Treatment depends on the severity of the injury and whether there are mechanical symptoms like joint locking:
Conservative Treatment:
Minor or degenerative tears can be managed with physiotherapy to improve muscle strength and stability, along with NSAIDs and relative rest. Avoid activities involving knee rotation or twisting.
Surgical Treatment:
If there are persistent symptoms or large tears, knee arthroscopy may be performed. During this procedure, the surgeon may repair the meniscus (if the tear is in the vascularised area) or perform a partial meniscectomy (removal of the torn part). Repair is preferred as it preserves meniscal function and reduces the risk of long-term osteoarthritis.
Rehabilitation
Rehabilitation following treatment, whether conservative or surgical, is essential for restoring full knee function. Physical therapy programmes focus on strengthening the quadriceps and stabilising muscles, improving range of motion, and enhancing knee stability.
In the case of surgical repair, weight-bearing is usually restricted for 4-6 weeks, and full recovery may take several months depending on the severity of the injury.recovery may take several months depending on the severity of the injury.
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