title: The Trapped Medial Meniscus Tear: An Examination Maneuver Helps Predict Arthroscopic Findings.
abstract: BACKGROUND
  Numerous clinical examination maneuvers have been developed to identify meniscus tears of the knee. While meniscus injuries vary significantly in type and severity, no maneuvers have been developed that help to distinguish particular tear characteristics.
  
  
  OBJECTIVE
  This nonconsecutive case series highlights a distinctive clinical finding that correlates with inferiorly displaced flap tears of the medial meniscus that become trapped in the medial gutter of the knee, as identified through magnetic resonance imaging (MRI) and arthroscopy.
  
  
  METHODS
  Cohort study (diagnosis); Level of evidence, 3.
  
  
  METHODS
  Eight patients with trapped medial meniscus tears were identified from a single surgeon's academic orthopaedic sports medicine practice between January 2009 and January 2012. Each patient underwent clinical evaluation, MRI, and arthroscopic treatment for meniscus injury. Clinical notes, MRI images, radiology reports, and operative findings were reviewed and compared in a descriptive fashion.
  
  
  RESULTS
  Each patient displayed a positive clinical examination finding of medial knee pain inferior to the joint line with flexion and the application of valgus stress in the setting of a torn medial meniscus and intact medial collateral ligament (MCL). Preoperative MRI revealed a distinctive flap tear of the medial meniscus flipped inferiorly to lay trapped between the tibia and deep fibers of the MCL. On arthroscopy, flap tears were found displaced inferiorly and trapped in the medial gutter in 6 of the 8 patients. Displaced meniscal fragments in the remaining 2 patients were found within the medial compartment.
  
  
  CONCLUSIONS
  Inferiorly displaced flap tears of the meniscus that have been displaced to the medial gutter can be localized through a careful examination technique.
  
  
  CONCLUSIONS
  Early identification of this injury pattern may help reduce the likelihood that the trapped fragment will be missed during arthroscopy.
authors.affiliation: Center for Hip and Knee Replacement, Columbia University Medical Center, New York, New York, USA. ; Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Herschmiller
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA. ; Rothman Institute Cartilage Center, Rothman Institute, Philadelphia, Pennsylvania, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Anderson
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: William E
authors.initials: WE
authors.lastname: Garrett
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Dean C
authors.initials: DC
authors.lastname: Taylor
keywords: examination; knee; meniscus tear