Can meniscal injury be effectively diagnosed preoperatively without ultrasound or advanced imaging?

In veterinary patients, meniscal injury is typically associated with cranial cruciate ligament deficiency (CCLD) and has been documented to occur concomitantly in 9.0-84.6% cases (McCready & Ness 2016)in canine patients and in 38-67% of feline patients (Harasen 2005; Ruthrauff et al. 2011). Isolated meniscal injury is rarely documented in the veterinary text and relates only to reports in dogs. In humans, isolated meniscal tears can occur at a frequency 60-70 in 100,000 (Fox et al. 2014). Given the limited data in cats, this presentation focuses predominantly on canine patients; using human literature for comparison. Meniscal injury in humans is recognised as a cause of significant musculoskeletal morbidity. In dogs, the role of meniscal injury in lameness appears somewhat more controversial. However, recent research suggests that presence of meniscal injury with concurrent CCLD will lead to reduced peak vertical forces and vertical impulses, suggesting meniscal injury can play a significant role in lameness (Wustefeld-Janssens et al. 2016)

Accurate diagnosis of meniscal injury typically relies on advanced diagnostic imaging techniques or visual assessment in both human and veterinary surgery. Surgical visual assessment still provides the most accurate detection of meniscal tears in canine patients. As there is some debate on the role of exploratory arthrotomy or arthroscopy in the management of CCLD stifles in dogs, accurate preoperative prediction of whether a meniscal injury is present or not, could be potentially beneficial for surgeons not routinely performing exploratory surgery.

In human orthopaedics and physiotherapy, various tests are described to assess for meniscal tears. Some of these tests are physically performed by an assessor (e.g. McMurray, Thessaly, Apley’s test) whilst others rely on communication of clinical signs and symptoms by the patient (e.g. joint line tenderness, pain on hyperextension, locking or catching of the knee). Overall, the predictive value of these tests in isolation has been shown to be suboptimal (Smith et al. 2015). However, composite scores from combining some of these tests have been shown to increase predictive values, although the presence of anterior cruciate ligament rupture and degenerative joint disease can lead to higher false-positive and false-negative rates, respectively (Lowery et al. 2006). [...]