Diagnosis
H&P
Positive McMurray test. Positive Thesally test.
MRI was done. Shows a meniscal tear.
Treatment
Physical Therapy and Exercise regimen.
Counseling: Studies have shown that meniscectomy for a tear of the meniscus is no more beneficial than conservative therapy in terms of functional status at six months. As such, we will continue for PT and exercise for several months even though improvement might be slow.
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In a high-quality RCT, meniscectomy and sham surgery were equally effective.
Appley, Thesally, and McMurry tests are all used for diagnosing meniscus tears.
Thessaly test. This test is performed by having the patient stand on one leg and flex the knee to 20°, then internally and externally rotate the knee. Rotate three times. The presence of pain in the joint line is a positive Thesally test.
Common Mechanism of action
Colliding with another player when playing. Usually, the player is unable to continue playing because of pain in the knee. The knee would become swollen subsequently. She may be able to walk but not without pain. Also, pain when she attempts to bend her knee.
Medial joint line tenderness and a positive Thessaly test are common on PE.
DDx to consider.
- Osteoarthritis
- Anterior cruciate ligament tear
- Collateral ligament tear
- Tibial plateau fracture
**”The presence of swelling immediately after the injury makes an internal derangement of the knee more likely, so osteoarthritis is less probable.” ABFM
If the patient is able to bear weight, a fracture is not likely.
Reference
Am Fam Physician. 2012 Feb 1;85(3):247-252. http://www.aafp.org/afp/2012/0201/p247.html