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Arthroscopic medial meniscectomy or repair
7%
164/2277
Arthroscopic lateral meniscectomy or repair
89%
2022/2277
Meniscus transplantation
1%
25/2277
Physical therapy with gradual stretching exercises
2%
45/2277
Corticosteroid injection for acute inflammation
0%
2/2277
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The clinical presentation is consistent for an acute bucket-handle lateral meniscus tear. He has a locked knee, meaning that he cannot fully extend because the meniscus has flipped into the notch. Arthroscopic lateral meniscectomy or repair is the treatment of choice. A repair is usually possible in large bucket-handle tears because the meniscus is torn in the red-red zone where most of the vascular supply is located. If the torn portion is badly frayed or damaged, a partial meniscectomy may be performed. Bansal et al. did a prospective study of 50 patients with an acutely locked knee. In all, 48 underwent examination and arthroscopy under general anesthesia. Among them, 43 were found to have distinct pathology causing a mechanical block to full extension. They argue a mechanical cause of the "locked" knee can be identified consistently using three key components from the history and examination: a history of a definite injury, localized joint line tenderness and the presence of an effusion. Turman et al. argue "because the meniscus serves many vital functions to the knee joint, the preservation of meniscal tissue through meniscal repair is ideal. Meniscal repair techniques have evolved over time from initial open repairs to inside-out and outside-in suture repairs to newer all-inside repair devices. The current gold standard remains inside-out vertical mattress suture repairs. All-inside repairs are best reserved for special circumstances, such as in the setting of concurrent ACL reconstruction." Incorrect Answers: Answer 1: One can determine that this is a lateral meniscus because the tibia is convex and has an anvil-like appearance, wheres the medial compartment has a concave tibia which looks like a champagne glass. In addition, the presence of the fibula confirms we are in the lateral compartment. Answer 3: Menscus transplantation is not indicated in this acute situation. Answer 4: Passive stretching may further damage the meniscus. Answer 5: Corticosteroid injection for acute inflammation is not indicated.
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