When should imaging, such as MRI, be requested for a patient with suspected meniscal tear in a general practice setting?

Magnetic resonance imaging (MRI) should be requested for a patient with suspected meniscal tear in general practice only when clinical assessment is inconclusive, symptoms persist despite conservative management, or when surgical intervention is being considered. Initial diagnosis is primarily clinical, based on history and physical examination findings such as joint line tenderness, locking, or restricted movement. MRI is not routinely indicated at first presentation because many meniscal tears can be managed conservatively without imaging ¹.

MRI is particularly useful when symptoms are severe, persistent beyond 6 weeks, or when mechanical symptoms such as locking or instability suggest a complex tear that may require referral to orthopaedics. It provides detailed visualization of meniscal pathology and associated knee structures, aiding in surgical planning if needed (Zanetti and Pfirrmann, 2006).

In summary, MRI should be reserved for cases where clinical findings are ambiguous, symptoms do not improve with conservative treatment, or when surgical management is being considered, aligning with NICE guidance to avoid unnecessary imaging and to optimise resource use in primary care ¹.