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96 m a s s a g e & b o d y w o r k n o v e m b e r / d e c e m b e r 2 0 1 9 technique MYOSKELETAL ALIGNMENT TECHNIQUES Testing for Meniscus Tears Expand Your Assessment for Accuracy By Erik Dalton, PhD 1 2 Almost everyone has a friend or relative who has had a "knee clean-out" due to a torn meniscus. This injury may happen suddenly, when the knee is fl exed and twisted, or gradually, as the result of age-related degeneration from prolonged repetitive stress. Symptoms of a torn meniscus include swelling, pain along the joint line, and inability to fully extend the affected knee. Of course, not everyone with this injury has symptoms. Many clients are unaware when it happens, and the symptoms, if any, might not appear for several weeks. If the brain decides to alert the client to the threat of possible tissue damage, the client may experience painful knee clicking, popping, locking, and catching. In addition, there may be a feeling of instability, as if the knee might give out, especially during movements such as walking up and down stairs. In this article, I'll outline simple assessments you can use to determine if a client with such knee issues is a good candidate for conservative care. The thick, rubbery meniscus cartilage aids in shock absorption, lubrication, and joint stability. Without the menisci, the area of contact between the tibia and the femur would not provide adequate knee stability. MENISCUS ANATOMY Before we begin, let's review meniscus anatomy to better understand how this tough tissue gets injured. Composed of thick, rubbery cartilage, the meniscus includes medial and lateral compartments located between the tibia and femur bones. Together they are referred to as menisci. The menisci are wedge-shaped— thinner toward the center of the knee and thicker toward the outside (Image 1). Functionally, these odd C-shaped structures are critically important for improving load transference. The knee is composed of a round femur sitting on a relatively fl at tibia, so without the menisci, the area of contact force between these two bones would be somewhat small and unstable (Image 2). When healthy, the paired medial and lateral menisci provide a great deal of shock absorption, lubrication, and joint stability to the actively engaged knee. Generally speaking, the meniscus has poor blood supply, but the outer third of the cartilage is vascularized. This means it may be possible to heal small degenerative longitudinal tears—good news for manual therapists attempting to mobilize or stabilize a knee with this type of injury. As far as the specifi c kinds of damage that occur in this part of the body, the medial meniscus is injured more often than its lateral counterpart. During a traumatic skiing or football accident, the meniscus, anterior cruciate ligament, and medial collateral ligament may all suffer serious injury. In sports circles, this season-ending condition is known as the "terrible triad." Lateral Meniscus Medial Meniscus Tibiofemoral joint without meniscus ASSESSING A TROUBLED KNEE It's important to note that many orthopedic tests taken alone have low inter-tester reliability. However, when the following three meniscus exams are combined, their sensitivity rating (ability to identify injured tissue) and specifi city rating (ability to rule out suspected tissue) improve