Consultation and diagnosis of meniscal lesions: how to properly assess?
During a consultation for knee pain, listening to the patient and a good clinical examination allow for the suspicion of a meniscal injury. MRI confirms the diagnosis and guides the choice of treatment, often conservative.
Doctors
Topics
Treatments
Advice
- Dr. Sylvia Morgado-Piçarra
- Anamnesis
- Clinical tests
- MRI
- Lesion typologies
- Conservative treatment
- MRI
- Clinical examination
- Conservative treatment
- Arthroscopy
- Assess the morphotype
- Don't rush to the MRI
- Examine joint stability
From complaint to diagnostic hypothesis
The consultation begins with a precise anamnesis: mechanism of injury, location of pain (internal or external joint space), episodes of blocking, swelling or acute popliteal pain. These elements already point towards specific injuries (bucket handle injury, radial injury, root avulsion).
The objective is to formulate hypotheses before imaging and to identify warning signs that require rapid treatment.
Complete clinical examination: morphotype and stability
The examination must be systematic: from the feet to the hips, integrating the axis of the limbs and the morphotype (varus/valgus). Meniscal tests and palpation of the joint space guide the location.
Ligament stability is assessed because it determines the future of the cartilage and influences the strategy regarding the meniscus. An irreducible flexum after trauma suggests a dislocated bucket handle.
You really have to weigh the pros and cons of surgical management.
Reasoned imaging: X-rays, MRI, MRI arthro-MRI
Outside of emergencies, weight-bearing X-rays (long axes, schuss views) are essential to assess osteoarthritis and load distribution. MRI confirms the type of injury and looks for associated damage.
Post-suture or in case of doubt, MRI-arthrography improves specificity. Imaging does not replace clinical reasoning: it complements and objectifies it.
Management of degenerative lesions
For degenerative horizontal lesions, the first line is conservative: relative rest, targeted physiotherapy, adaptation of activities, NSAIDs if necessary, possibly infiltration. The majority of patients progress favorably without surgery.
This strategy reduces exposure to meniscectomy, the biomechanical consequences of which are now well documented, particularly in the external compartment.
Radial lesions quickly lead to osteoarthritis.
Surgical situations: targeted indications and associated procedures
Surgery is reserved for failures of well-conducted treatment, unstable lesions (flap, bucket handle) or radial/root tears. Partial meniscectomy should be used sparingly; it may be accompanied by an axis correction procedure (for example, marked varus) to protect the affected compartment.
Each indication is weighted by age, activity and cartilage quality.
Key point: preserving the meniscus for the future of the knee
Tissue preservation remains the guiding principle: repair when possible and limit resection otherwise. This approach reduces the risk of secondary osteoarthritis and maintains function over the long term, particularly in active and athletic individuals.
Personalized assessment takes precedence over standardized protocols.
Français 
English (UK)