Diagnosing meniscal tears in the emergency department

Acute meniscal knee injuries can lead to instability of the joint if they are left untreated, but clinical examinations of patients' acutely injured knees can be challenging because of the pain and swelling involved. Although magnetic resonance imaging and arthroscopy are the gold standard investigations for the diagnosis of meniscal tears they cannot always be carried out in acute or emergency department settings. It is therefore essential that emergency care practitioners have good clinical examination skills to ensure safe and effective patient management, diagnosis, and outcomes, as well as the skills and knowledge required to carry out meniscal tear tests. This article reviews the literature on the most common examination techniques associated with acute injuries, especially meniscal injuries, to knees: joint line tenderness assessment, McMurray's test and the Apley's grind test. It analyses the sensitivity and specificity for each test to help practitioners understand the clinical significance of positive and negative findings.