Ligamentous and meniscal injuries of the knee rarely require emergent evaluation in the ED. Initial treatment of these injuries includes RICE therapy (Rest, Ice, Compression, & Elevation) and gentle ROM exercises . At times, the meniscal tear can flip back resulting in a return of range of motion . The patient should be made non-weight bearing and be provided crutches.
Pearl: Multi-ligamentous injury of the knee requires further assessment – this is an unstable joint with risk for neurovascular injury (eg. popliteal artery dissection).
Pearl: MRI of the knee without contrast is the imaging of choice as an outpatient, which helps accelerate outpatient surgical management . See the below images.
Image 2. MRI T2 sagittal demonstrating a complete tear of the anterior cruciate ligament. Image courtesy of John Kiel, DO.
Image 3. MRI T2 coronal demonstrating a bucket handle medial meniscus tear. Image courtesy of John Kiel, DO.