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Suspected traumatic lateral meniscal tear — MSRA MCQ

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ModerateKnee InjuriesSuspected traumatic lateral meniscal tearMSRA

A 34-year-old secondary-school teacher presents 7 weeks after twisting his right knee while pivoting during football. He had lateral knee pain and a small effusion the following day, but no rapid swelling or sensation of instability. Since then, he has had uninterrupted lateral joint-line pain, worse when turning or squatting, with intermittent catching but no fixed block to movement. He walks independently. There is focal lateral joint-line tenderness and lateral pain reproduced by Thessaly testing. He has full active and passive extension and flexion to 125 degrees. Lachman, posterior drawer, varus and valgus stress tests are normal. There is no effusion or neurovascular deficit. Knee radiographs performed after the injury were normal. What is the most appropriate next step in management?

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Correct answer: E — Arrange a non-urgent MRI of the knee through the local primary-care/MSK pathway

This presentation meets criteria for direct MRI assessment of a suspected traumatic meniscal injury: he is under 50 years old, has had uninterrupted symptoms for more than 6 weeks, and has lateral joint-line tenderness with a positive meniscal provocation test. Normal radiographs and the absence of ligamentous laxity make an occult fracture or clinically significant ligament insufficiency less likely, but do not exclude a meniscal tear. Urgent orthopaedic assessment for arthroscopy is inappropriate because he does not have a true locked knee: he has full passive extension and flexion, and the catching is intermittent rather than a persistent mechanical block. A further period of rehabilitation would be reasonable earlier after a less significant injury, but the persistence and meniscal features now meet the local threshold for MRI. Intra-articular corticosteroid injection is not first-line for a suspected traumatic meniscal lesion and may obscure assessment without addressing a potentially treatable structural injury. Repeating radiographs is unlikely to add value because adequate initial films were normal and the current concern is intra-articular soft-tissue pathology.

Reference: Acute knee pain — DGRefHelp, NHS Dumfries and Galloway (Reviewed 11 December 2024) — https://www.rightdecisions.scot.nhs.uk/dgrefhelp-nhs-dumfries-galloway/musculoskeletal-system/knee/acute-knee-pain/ MRI Criteria — NHS Tayside RefGuide (Current page, accessed August 2026) — https://www.rightdecisions.scot.nhs.uk/nhs-tayside-refguide/surgery-and-orthopaedics/orthopaedic-and-trauma-surgery/knee/mri-criteria/?topic=nursing-midwifery