Acute meniscal tear

A tear to meniscal cartilage in the knee which can be traumatic or atraumatic. Typically presents with mechanical symptoms such as giving way and locking

History

Young to middle age
Twisting injury
Kneeling/squatting injury
Joint line pain
Difficutly walking
True locking

Signs

Limp
Effusion
Joint line tenderness
Possible painful block to extension

Meniscal tear

Unable to kneel, squat or Duck waddle

Meniscal tear 2

McMurrays Test

Who to refer, who not to refer, how to refer

Who to Refer

True locking
Giving way
Reduced ROM
Ongoing pain despite rehab

Urgent Referral Criteria

Locked Knee

Who Not to Refer

Atraumatic tear of meniscus ( degenerative tear usually in presence of OA ) – for APP review

Additional Info

Unlikely to operate acutely unless true locking and giving way
Unlikely to operate BMI >40

Imaging

WB Knee X-ray if over 45 (Ideally xray is < 1yr old)
<45 yrs MRI

How to refer

We accept referrals through SCI gateway for those who are based in Scotland.

We also accept e referrals through the below email address using the attached form for those who are based just on the other side of the border.

E- Referral Email address - bor.orthoreferrals@borders.scot.nhs.uk

Referral form - E-Referral to Orthopaedics (Non Sci-Gateway)

Primary care management

Physio rehab
Regular maximum multimodal analgesia
CSI X 2 if felt appropriate/possible -over 45 years old
Walking aid
Education
BMI >35 engage in wellbeing support

Resources and links

Primary Knee Pathway - developed by First Contact Practitioners (To be confirmed, will update when available) Primary Knee Pathway

Local service details

orthopaedics@borders.scot.nhs.uk

bor.orthoreferrals@borders.scot.nhs.uk