What are the key clinical features that help differentiate a meniscal tear from other causes of knee pain in primary care?

Key clinical features that help differentiate a meniscal tear from other causes of knee pain in primary care include:

• History of a twisting injury or trauma: Meniscal tears often follow a twisting movement of the knee, especially when the foot is planted, which is less typical in other knee pathologies ¹.
• Mechanical symptoms: Patients frequently report locking, catching, or clicking sensations within the knee joint, which are more characteristic of meniscal injury than osteoarthritis or ligamentous injuries ¹.
• Joint line tenderness: Palpation along the medial or lateral joint line typically elicits localized pain in meniscal tears, helping to distinguish it from more diffuse pain seen in other conditions ¹.
• Effusion and swelling: Acute or recurrent joint effusion may be present, often developing hours after injury, which can help differentiate meniscal tears from chronic degenerative causes ¹.
• Range of motion limitation: There may be a reduced range of motion, particularly difficulty in fully extending or flexing the knee, due to mechanical blockage from the torn meniscus ¹.
• Absence of ligamentous instability: Unlike ligament injuries, meniscal tears usually do not present with significant joint instability on clinical examination ¹.

These features, when combined, help primary care clinicians distinguish meniscal tears from other causes of knee pain such as osteoarthritis or ligament injuries. The NICE guideline NG226 emphasizes the importance of clinical history and examination in diagnosis, reserving imaging for uncertain cases or when surgery is considered ¹. Jackson et al. (2003) support this approach, highlighting that mechanical symptoms and joint line tenderness are key discriminators in acute knee pain evaluation in primary care (Jackson et al., 2003).