Degenerative 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. Degenerative tears are usually associated with early OA

History

Middle age
Pre existing early OA
Minimal injury
History of overuse eg DIY
Limp
Restricted work
Localised joint line pain
Possibly swelling

Signs

Limp
Effusion
Joint line tenderness
Possible painful block to extension

Unable to kneel, squat or Duck waddle

McMurrays test

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

Who to Refer

True locking
Giving way
Reduced ROM
Failure to settle despite non operative measures

Urgent Referral Criteria

Locked Knee
Red flags

Who Not to Refer

Those who have not exhausted non operative measures – see primary care management

Additional Info

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

Imaging

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

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- strengthening over extended period
Regular maximum multimodal analgesia
CSI X 2-3 is possible (if aged 45 and over)
Walking aid
Education
BMI >35 engage in wellbeing support

Resources and links

Primary Knee Pathway - developed by First Contact Practitioners Primary Knee Pathway

Local service details

orthopaedics@borders.scot.nhs.uk

bor.orthoreferrals@borders.scot.nhs.uk