Meniscus Injury Grading
Aug 24, 2022
Source: Cainiu Health
Dr. Lin Yunfei
Introduction
Meniscal injury grading is primarily determined by MRI. Generally, injuries are classified into four grades:
Grade I: The tear is confined to the meniscus and does not extend through it.
Grade II: The tear extends to the synovial side but does not reach the articular (joint) side.
Grade III: The tear extends to the articular side.
Grade IV: There are multiple tears within the meniscus.
Diagnosis of meniscal injury is primarily based on patient history and clinical examination. Most patients have a history of trauma, with localized, persistent pain and tenderness over the affected joint space. A comprehensive analysis incorporating various physical examination findings enables accurate diagnosis in most cases. In patients with severe trauma, it is essential to assess for concomitant injuries to the collateral ligaments and cruciate ligaments. So, how is meniscal injury graded?
Grading of Meniscal Injury
Meniscal injury grading is primarily determined by magnetic resonance imaging (MRI). Generally, injuries are classified into four grades: Grade I: Intra-substance signal abnormalities confined within the meniscus without extension to either surface. Grade II: Linear signal abnormalities extending to the synovial surface but not reaching the articular surface. Grade III: Signal abnormalities extending to the articular surface—indicating a true tear. Grade IV: Complex or multiple tears resulting in meniscal fragmentation. Typically, Grade I and II injuries occur without a clear history of trauma and are commonly associated with degenerative changes in older adults.
Patients with Grade III or IV injuries can usually recall the exact time of injury. Following the injury, they experience acute, severe joint pain and swelling. As the acute pain and swelling subside, symptoms often evolve into chronic joint pain. Pain intensifies during walking or vigorous activity, and patients may experience “locking”—a sensation that the joint is stuck in a particular position, preventing full flexion or extension; however, spontaneous unlocking may occur upon movement. For confirmed Grade III or IV tears, surgical intervention is generally recommended—either arthroscopic meniscal repair (suture) or partial meniscectomy.
Patients may require further surgical treatment, including meniscal repair (suturing) or meniscal reshaping (meniscoplasty). We hope this information is helpful to you.
