Physical Signs of Meniscal Tear: Red Herrings in All But the Young

Nov 16, 2013

(VIDEO) Another dictum from medical school gives way to medical research: Clicking, popping, and locking are not useful for diagnosis and prognosis of suspected meniscal tear in patients over 45. Harvard's Dr. Jeffrey Katz reveals signs that actually are informative in this age group.

Popping, clicking, catching, locking, giving way: You may have been taught that these are useful signs to diagnose meniscal tear. Not true for patients over age 45 who tend also to have osteoarthritis, patellofemoral disease, or both, says Jeffrey Katz MD of Brigham & Women's Hospital and Harvard University.

These same traditional physical signs are also misleading as prognostic indicators in the older age group, it turns out.

Briefly summarizing two reports to the American College of Rheumatology 2013 annual meeting, in this video Dr. Katz describes new information on the subject from patients in the recent METEOR trial randomized to either meniscal surgery or physical therapy for symptomatic meniscal tear.

It's "a real departure from all that we've learned from younger people with traumatic tears," says Dr. Katz. "It turns out that it's a different disease in middle-aged and older people, so we have to kind of rethink our rules of thumb about diagnosis and prognosis."

However, he reveals a few tip-offs that are useful in this age group: The duration of pain,the location of audible or palpable crepitus, and whether and where the patient can point to certain locations on the knee as the source of the pain.