chapter 7: nonarthritic anterior knee pain

Meniscal Lesions

Meniscus tears can cause chronic effusion and eventually patellar articular cartilage softening. Many patients point to the anterior knee when asked to localize knee pain, much as patients with abdominal pain will frequently point to the umbilicus. The astute clinician, however, will rely on a careful and thorough clinical examination to differentiate between meniscal pathology and patellofemoral pain. By carefully examining the peripatellar retinaculum, distal quadriceps muscle, patellar tendon, infrapatellar recesses, and patellar articular surfaces, one can generally localize a specific pain source in the patellar or peripatellar region as opposed to distinct tenderness along the medial or lateral joint line, which would be suggestive of a meniscus tear or arthritis. One must recognize, however, that snapping, popping, and even locking may occur with patellar problems. Again, clinical examination can often differentiate the source of a pop. Pain on full flexion of the knee with rotation and tenderness at the medial or lateral joint line is more suggestive of a meniscus tear. When differentiation is critical, magnetic resonance imaging may be helpful.


        

Inside Chapter 7: