Knee Pain , Meniscus tear - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes knee pain examination of the meniscus.
There is two types of cartilage between the femur and tibia:
• Articular cartilage
• Meniscus cartilage
And there is a meniscus in between.
The meniscus is a fibrocartilage structure that carries type I collagen, it is triangular shaped in cross section.
There are two menisci:
• Lateral meniscus:more mobile that the medial meniscus
- Circular
- Covers about 70% of the lateral tibial plateau
• Medial meniscus: its tears occur about three times more than that of the lateral meniscus
- C-shaped
- Covers about 50% of the medial tibial plateau
Function:
• Shock absorption
• Load sharing
• Joint stability
Meniscal tear causes:
• Twisting, jumping, or changing directions during sports activities such as skiing or football.
• Degenerative tears of the medial meniscus may occur in older patients.
• Degenerative tears may occur in association with arthritis.
Symptoms of the meniscal tear:
- Pain on the medial or lateral side of the knee
Mechanical symptoms:
- Locking
- Clicking
- Swelling
Examination:
Joint line tenderness is the most sensitive exam; posterior knee pain may also be present when the knee is bent.
Look for the knee joint effusion, effusion may be difficult to find and occur several hours to appear after the injury.
With ACL tears, the hemorrhage and swelling is greater and develops rapidly.
Mcmurray’s test is used to diagnose meniscal tear, a painful pop or click is obtained as the knee is brought from flexion to extension with either internal or external rotation of the knee.
To test the medial meniscus, flex the knee and place the hand on the medial aspect of the knee.
The knee is then extended in order to test the medial meniscus.
Feel a pop or click with knee extension, the patient will experience pain.
A positive test is indicated by pain, clicking, or popping within the joint and may signal a tear of the medial meniscus.
To diagnose the lateral meniscus tear, do the Mcmurray’s test with internal rotation of the knee.
Sometimes the knee is locked with lack of full extension due to a bucket handle tear of the meniscus.
Differential diagnosis:
• The clinical diagnosis accuracy of meniscal tear is about 70%.
• MRI is usually done to confirm the diagnosis or identify other problems in the knee.
• The differential diagnosis can be intra-articular problems or extra-articular problems.
• Intra-articular problems:
- Medial synovial plica irritation.
- Osteochondritis lesions (OCD).
- Patellofemoral pain
- Loose bodies
• Extra-articular problems:
- Collateral ligament injury, especially the medial collateral ligament
- Pes anserine bursitis
- Lumbar disc herniation
- Stress fracture
- Iliotibial band syndrome
- Slipped capital femoral epiphysis (SCFE).
Blood supply:
The meniscus receives blood supply from the genicular vessels and its capsular attachment.
The peripheral 1/3 area is the most vascularized area and tears within this area usually heal.
Where is the tear located?
Treatment of meniscal tears:
• Nonoperative:
- Especially for small nondisplaced tears and degenerative tears.
- Physiotherapy
- NSAIDS
- With persistence of symptoms, cortisone injection may be given.
- When the conservative treatment fails, then do surgery.
• Surgery:
- Excision of the tear (partial meniscectomy): you do excision if the tear is complex, degenerative, or if it is a radial tear that cannot be repaired.
- Repair of the meniscal tear: usually done for a peripheral tear which is vascular and will heal.
It is better to have the combination of repair of the meniscus at the same time you do ACL reconstruction (controversial).
- Meniscal transplant: done in younger patients who had total meniscectomy (especially lateral meniscus).
It takes about one year for the graft to heal.
Re-tear of the transplanted meniscus is also common.
If you do total meniscectomy, this will probably lead to future arthritis of the knee.
Special situations:
• In general, medial meniscal tears occur more often than tear of the lateral meniscus.
- In older patients, the posterior horn of the medial meniscus is usually more often affected.
• With ACL tears that are acute, then there will be more incidences of lateral meniscal tears.
• With ACL tears that are chronic, then there will be more incidences of medial meniscal tears.
• With tibial eminence fractures in children, the medial meniscus can become trapped in this injury.
• Tibial plateau fractures:
- If the injury is medial then it can affect the medial meniscus.
- If the injury is lateral then it can affect the lateral meniscus.
• If you have depression or displacement separation more than 5 mm, you can have meniscal injury.
Discoid meniscus: the meniscus is usually larger than normal and occurs more in the lateral meniscus, the treatment is usually saucerization plus or minus repair of the lateral meniscus if symptomatic.

[@piotrpiotr566]

Great material - one of the best I've seen on the meniscus. Thank's a lot.

[@igor8105]

Good afternoon Dr, Nabil, I'm Igor Bertola, I'm a physiotherapist. I wanted to thank you for all these teachings. Embrace of a Brazilian.

[@cristianvega474]

This video has been more helpful then the scamming "dr." I went to today, thank you for actually caring about what you doo!!!! 🙏🏽🙏🏽🙏🏽

[@wmdoux2108]

I’m going in for an knee MRI and this is the most informative video I’ve seen since researching my problem. Thanks!

[@osmanosman7037]

How us goes for know you are mri

[@pcgamerz9271]

I'm also gonna do an mri how are u now?

[@41Ransom]

Having had the procedure at age 17, and now at 79 an other tear has occurred on the same knee. I found your explanation to be very good!

[@randomvidz8742]

Old man I'm 14

[@ReR7474]

Yeah that’s why they don’t suggest these days operations even in older people) unless necessary because it may happen again years

[@omstygomsty]

Did you develop arthritis?

[@rpvgirl]

Thank you Dr Nabil for explaining this in lay man's terms!

[@vegforce4518]

Lovely explanation. I thought I had a medial meniscus problem after a knee bump but on MRI it turned out to be bone edema, although some minor meniscus wear was apparent (cyclist 51 years, 6 year vegan). Complete recovery after 2 months.

[@imperialchalice]

vegforce 👏

[@tjadventures9163]

What does being vegan have to do with anything

[@georgebeard3319]

@@tjadventures9163 Actually alot, since I turned vegan I recover much faster from illness and injury, so I guess this is universal

[@derekc6445]

@@tjadventures9163 A lack of B12 which is needed to maintain bone strength.

[@samirpatel9568]

What an amazing video anyone who is concerned about the knee pain must watch it you can learn a lot about it thank you Dr.

[@user-wp8jm1wt7j]

Sir is the pain feel behind the knee or Infront of the knee

[@mahastianvaripour6097]

Thanks Dr. Nabil Ebrahim. That was the best video explaining Meniscus Tear, very simple and understandable.🙏🏼👏🏼

[@arshadbaig7904]

Dr. Nabil, you explained it in very simple methodology that anyone can understand easily, wonderful slides. Thanks again...

[@martinjaimes255]

Thank you doctor, this is the best explanation of this type of injure. I got to diagnose myself due to the quarantine. I think I got a left knee lateral tear. I have been doing some exercises I found on the web, and I have improve my mobility a lot, the only remaining symptom is a click, no pain most of the time, but still bother a lot.

[@d0ha.k]

How is your condition? Improvement ? Diagnosed the hospital? . I got diagnosed for Transverse linear high SI seen at posterior horn of lateral meniscus. I have limited mobility with pain and it is so annoying

[@smruti009u]

I just love your videos , orthopedic was one of my difficult subject in undergraduate years, but in just a week , through your videos , now its one of my fav subject. Thank you a lot Dr Ebrahim.

[@onlythewise1]

look up dr. kerlan and jobe doctors

[@ZENSIBLE]

@@onlythewise1 The Best Orthopedic in Cali for sure

[@onlythewise1]

@@ZENSIBLE yep they did me

[@jadalynvee]

I have been waiting for an MRI for a month a half. This has been the most informative video I have seen so far. I now know what questions to ask during my next doctors visit. Hoping for an MRI soon.

[@capstone1073]

Very informative. Wish I had this information 11 years ago before my surgery. Now my knee is worse than ever and it looks as though I have a meniscus tear again.

[@somisolomon]

Is yr surgery sucess?

[@highphysics3617]

An absolutely detailed,thorough,informative video. Excellent presentation. The pain is almost bearable knowing what it could be.

[@MrChristian]

Wow, what an incredible video.. I've learnt so much, thank you Doctor!!

[@MN-ix6ou]

An excellent and complete lecture! Thank you

[@windsurfsnow]

Great video Dr. Nabril Ebraheim. Very detail and descriptive in a way a layman like my self could understand my injury.

[@safdardahriwal7503]

Sir please upload some stretching or strengthen exercises for the problem thank you

[@georgerisk9784]

An absolutely detailed thorough informative video. Excellent presentation.

[@michelleblackwell2884]

Best video I’ve seen! I’m convinced that I have messed up my meniscus. Gonna make an appointment Monday morning!

[@shankarga7808]

excellent video sir. step by step therapeutic teaching. am from Chennai, India. well explained the differential diagnosis of knee pain. thanking you sir.

[@eastcoastin_]

The knee sure is a complex body part. Thank you for your flawlessly detailed video, Dr!

[@nabilebraheim]

thank you

[@eastcoastin_]

Sir, I've been having symptoms of semi-sharp pain located under the highest point of my patella in the center only when I straighten my knee all the way (and sometimes from squatting to sitdown). From what I've been reading, seems like an Articular Cartilage injury. What would you say about my issue, Doc.?

[@bobmester3475]

I have a tear in the posterior horn of my medial meniscus confirmed by MRI. I have read and seen many videos about the issue and this video is by far the best and most complete I’ve seen. Thank you for this! My choice has been not to do surgery but this video is perfect for understanding your condition and reviewing options.

[@spongebobsp100]

Bob, I have been diagnosed the same. Have pain on medial and back side when squatting on toes. How Is your recovery if you are still following this thread? Thanks.

[@bobmester3475]

@@spongebobsp100 hi David. Thanks for asking. I’m sorry to hear you have a similar issue. I’ve pretty much returned to normal activity without surgery but I just walk now and don’t do more active sports that involve running or cutting movements. I decided against the surgery since I’d read only about 30% were successful in my case and could lead to arthritis in that knee. I’m 72 though so if you are younger you might want to consider the surgery. For my everyday activities I’m 100% now. You might want to check out Pete Egoscue’s book “Pain Free”. His exercises have helped me a lot in my recovery. Best regards, Bob

[@spongebobsp100]

@@bobmester3475 thanks for getting back and wish you the best. I think I am going to be greatly disappointed. I am an active casual badminton player and seems like I am going to miss the sport big time.

[@bobmester3475]

@@spongebobsp100 I feel your pain David. I was 1-2 times a week soccer player for many years so it is really hard to not be able to do that. I hope you can find alternatives you can still do. Take care!

[@Bkbond]

I'm 26 now i have same problem, confirmed by an MRI, any suggestions for me

[@aci.]

This is a very good discussion of meniscal tears.

[@mamababy60]

I really enjoyed this video. The doctor really broke it down and made it clear to me.

[@billparry3591]

Great information

[@pgolami7]

Thanks so much for this video. Learned a lot about meniscus tear that I am diagnosed.

[@jomaretang9669]

What procedure is needed for this findings "there is complex tear seen in both lateral meniscus with lateral extrusion of the body of the lateral meniscus, measuring 4.5mm away from the inner tibial plateau."

[@tbone1493]

Thank you for taking the time to do this.

[@gemmapaglinawan]

Thank you very much for the information. Love to hear from professional like you

[@ShoaibKhan-ns5tp]

Absolutely very much informative n perfect way of explanation 👍👍👍👍👌👌

[@teresashen9162]

❤ so good. This is the best meniscus video 🎉 well done for all the work ❤

[@konstantinosganatsios579]

An exellent presentetion ,An absolutely detailed ,thorough,informative video thanks Dr Ebraheim"s for this Lovely explanation

[@mud1949]

Thank you so much. All that information makes me a better patient.

[@spaceanon5930]

I wish you were my Dr. Washington state could sure use some good Dr.'s. You have such a pleasant speaking voice and did such a good job explaining.I currently have tears in each meniscus Rt.& Lt. but I also have arthritis so I havnt a clue what this new orthodox Dr.is going to do and I'm very uneasy about it. thanks for sharing Dr.

[@HalfassDIY]

Outstanding summary of the pertinent facts. Thank you !

[@wolfemanbog4176]

This is a great video with great detail I injured my left knee at work I twisted it and rip the meniscus I can’t bend knee with out pain and walking lots of pain clicking sound also I can’t put the leg straight with out pain I can’t walk more then 2-3 minutes with sever pain

[@user-zx9eg2fg5c]

An absolutely detailed thorough informative video. Excellent presentation.. Wow, what an incredible video.. I've learnt so much, thank you Doctor!!.

[@akberm3866]

Thank you for this detailed explanation, very well explained

[@lavarip]

So precise and complete information. I'm grateful for your videos.

[@Kingdom_of_God777]

Excellent video Doctor! Much appreciation and thanks to you sir

[@MsVivian99]

Really helpful and much appreciated. Thankyou

[@vipulmita]

Very informative and detailed in layman terms as well. Thank-you for this Video. Hope to see more educational videos from you.

[@ridgebriar17]

Agree.

[@d5434]

This is informative. I have an impact injury, from smashing my knee straight onto a cement floor after slipping in applesauce, I did not see. This has been terribly painful and I have not really had any more than an MRI 5months after injury. I am on TD, was very fit even at 58. I want to heal without sugery, but there is more going on than just my 2 menisci tears.

[@kathym6603]

I guess you know you have no broken bone. Here are two good videos: (1) Treatment for Meniscus Tears - Tips My Patients Find Useful (2) Meniscus Tear? 3 Signs Surgery Might Be Needed

[@dontwastetime90]

Now I wanna cry

[@user-ix9wx6ms9v]

Very good illustrations with clear explanation. Thank you.

[@rickdmon1dancing769]

This video is amazing!! You are my doc on knee problems now?? Thank you!!

[@AdreamlyfeByMichelle]

I got good news today after months of pain and taking care of myself... the tear is small enough and near the area where blood is circulating that my ortho believes I will heal very well. Therefore be able to go back to roller skating and all the things I love to do physically! Yessss !! That was very scary

[@viteknamasine]

Thank you for your time to do this video!

[@denisehobart2988]

Im getting ready for knee surgery. Thank you this was very informative!!!

[@das8771]

I tried everything I could to fix my sore knee. After 6 months had meniscus repair surgey. The original pain is gone within 4 weeks and the knee is getting stronger everyday.

[@somisolomon]

Hiiii... DA S

[@somisolomon]

Now i am suffering meniscus tear about 6mth...

[@somisolomon]

I am afraid of surgery...

[@krystiandawiec8729]

Thank you very much Sir for all valuable teaching you post on the KZbin!!

[@indikapathirathne9366]

Very clear and short and sweet information.

[@jk0897]

Thanks. Very informative. I'm going through meniscus surgery deliberation.

[@dubtownman9508]

Fantastic breakdown of this issue 👌

[@NerdyMina]

That was very informative. Thank you!

[@saipetro3479]

thanks nabil for your detailed explanation. thanks a lot.

[@aparnas5823]

Like this vdo very much ,,,,most informative vdo ,,,,well explained so that non medico person also get proper idea of what exact is happened in our knee,,, I am non medico ,,,and have meniscus tear and suggested arthroscopic surgery so surfing for vdos to get an idea of the surgery ,,, resection or repair which is better for meniscus tear

[@stephen5147]

Excellent video! Thank-you very much for education. Very helpful.

[@user-hh7rf2qi6s]

that was so helpful thank you doctor nabiil

[@waheguruwaheguru9176]

Beautifully expained 🥇 superb animation 🌴 tks 🙏

[@Heipen]

Hi, I really learned alot from this video, now I feel confident I understand what my doctor was explaining to me about my injury. How ever, the diagnostic methods explained in this video were of no help. I guess my case fell to the 30% that could not be diagnosed with the traditional manipulation tests. I'm 32 year old male with an active lifestyle.I had a medial meniscus tear on my left knee, with no clear cause for the tear. The surgeon ended up partially removing the medial meniscus and partially repairing the tear wtih a scorpion suture. Some signs of arthritis in the posterior horn are also present. The McMurray's test or any other manipulation tests did not give a positive dianose of any injury to the knee only after MRI I demanded to get and was initially refused gave a clear diagnose of the situation.. Longer walks or even a few running steps caused severe pain and partioa immobility of the knee, MRI images gave a clear picture of the condition of the knee. Bucket handle tear and possible arthritis. Also a bakers cyst and a meniscal cyst were found. In some cases the traditional diagnostic tools are not enough. This was also the case with my right knee 10 years ago. My doctor ended up telling me that my injuries would have probably been less severe and problematic if the diagnosis were to be accurate the first time I went to see a doctor with this issue.

[@iangottmusic]

Heipen same here, went to the ER after a knee injury from climbing, they did a X-Ray and the McMurray’s test and said I had mild case a tendonitis, and gave me a ace bandage and no pain management. I insisted I was concerned I had a meniscus tear so they gave me a follow up with a orthopedic surgeon, they gave me a MRI, I have a bucket handle tear and will need surgery.

[@Kevin-vk5tx]

I have the exact same findings from my MRI, how are you doing now?

[@dslatimer]

I would like to hear your follow up and recovery story. Great reply!

[@noeljohnson3918]

Thank you for the complete illustration. Now I don't think I have a meniscus tear. My injury is due to a tibia plateau fracture with 3mm displacement. I think it might be that tendon in front of my knee. Five months after the fracture, everything else is fine. Just that pain across the bottom of my knee in front.

[@kathykitten6]

Very Clear Information. Thank You Very Much!

[@MuhammadArif-vd1yq]

Thankyou for explaining meniscus tear

[@gudsonlalsangliana7611]

Now I know the pain i bear for years...thank you🫡

[@carriehollyland3596]

My doc thinks I may have damaged both my meniscus and ACL. I go next week for an MRI.

[@mmnn4845]

Thanks for all the information. They are life changing

[@harmonyintouch]

Excellent and informative video. thanks!

[@karennorris7880]

Lots of great info! Thanks

[@skywaytourstravels2199]

THANK YOU

[@EriqKoontz]

Excellent and informative video. Thank you!

[@AyeshMedic]

AMAZING!!! I miss making Medical Vlogs. My exams are starting from 25th March. This is freakin... 😬🥺

[@peshpraq5137]

Thank you very much , very useful .God bless you sir .

[@najiahaimd4269]

Thank you so much for this informative video.

[@pierrevillemaire-brooks4247]

Thank you for sharing this information !

[@kimlewis5429]

I understand much better after viewing this video ..thank you

[@thingsaroundus4714]

this video cleared all confusion thank u very much dr.nabil sahab

[@ESLinsider]

Some other things you can try besides waiting, surgery and rehab. Injections that may help heal it: 1. PRP 2. Stem cell 3. Prolotherapy 4. Peptides: BPC 157, TB500, AOD9604 and maybe ipamorelin (growth hormone secretagogue) 5. Growth hormone injections I would stay away from partial meniscectomy if you consider surgery. That might make you feel better in the short run, but likely lead to arthritis studies say even if they cut out a little. Tore my meniscus for the second time. Trying peptides now.

[@AdreamlyfeByMichelle]

Wow what an incredible video! Thanks so much.

[@senzaization]

Excellent breakdown👍🏽

[@nowchakri2000]

lot of visibility thank you so much

[@analarson2920]

The non-operative treatment is only for symptoms, how does that heal the meniscus? Most people I know end up completely tearing it, why not surgery and nutrition changes with weight loss management and physical therapy that protects the joint but allows healing? How about adult stem cell therapy instead of transplant? Thank you for the details and explanations, you do a far better job than most orthopedic surgeons do.

[@ruthie2222]

What a great video! Thank you! 👏

[@yingcao6399]

MaMurray test is no longer recommended in the NICE guidelines due to concerns that it may exacerbate the injury and due to its low diagnostic accuracy. Is it true? thanks

[@djsawyer01]

Thank you for your education...... Awesome and amazing Doctor. I hope to meet and shake your hand one day.

[@ParamjeetSingh-mv3yy]

So good brief description

[@vincentgodley5817]

Thank you very muvh for your great information on the Meniscus.

[@MinhNguyen-li2eb]

Amazing!! Thank you so much!! Very useful for me. Can you share your references ?

[@kimathomenow1]

Thank you. Very informative.

[@SportGuyDMV]

This was a great video. I am 27 unfortunately I had a complex tear in my medial meniscus. Happened aug 2022. 1 horizontal tear in the red zone and 1 horizontal in the white zone. Got the repair done unfortunately the tear in the white zone retore. I have very bad mechanical symptoms it is difficult for me to walk. My knee clicks. For me this has been very hard to overcome. I did PT for around 5 months before i got my first surgury and didn’t feel an improvement. I can either go through life in pain and very limited mobility. Or I can get partial meniscectomy to address the problem but most likely get osteoarthritis later in life. Its a hard decision and a very unfortunate injury to get.

[@sathsmedia8190]

same for be bro.. did surgery for MM bucket handle tear, but after 10 month got tear on same are as complex tear.with mikd pain and stiffness . icing and doing minimal walking ..for month . my mindset is read for next surgery ,, bcoz life is irritating..

[@emmazhao5362]

The best one so far

[@SKLMJanasenaPSPK]

Great vudeo, thank u sir... I got more info on jnee joints

[@SerhatCokZorlu]

You are the one!

[@marives8]

In Jan 2020 i tripped w/ right knee & fell body weight. Only my arms saved my face from slamming on cracked sidewalk. My knee bled a bit & took a 2 mos for the deep cut to dry, heal & eventually pain went away. I was able to resume my walking exercise (2-3 mi only) & once a 5 mi around the lake.

[@marives8]

I was fine from April 2020 till July 2021 when AFTER WALKING:SHOOPING in an outlet for 4hours my knee started to feel an intense burning pain. Then i started limping to avoid pressure & had difficulty up/down stairs. Xrays in Aug & Nov yielded negative results. An MRI in Dec said mild Meniscal tear. Primary recommended PT but didnt improve much.

[@smilechandol]

thank you Dr Navil !!My name is chanyoung Jeong and l an athletic trainer in Korea. I love your video! I have watched and studied use your video for 2years. I worry about English but if you don' mind I'd like to communicate with you by e-mail sometimes. thanks every time and help us.

[@nabilebraheim]

thanks

[@sheelajohnson9751]

Thank you doctor,🙏

[@pushpakhadka6988]

Thank you very much,sir...so grateful

[@TheJaneille]

I have to do it again at what the ER doctor said so I hope my knee pain this time I will do therapy list to doctor just pray for my recovery

[@ayawali]

Great video. Thank you Dr Nabil.