Clinical quiz: intermittent knee pain

 


A 42-year-old male accountant presents with a three-month history of intermittent right knee pain and episodes of mechanical locking.

He denies any specific injury but reports that the knee sometimes “catches” or locks in place when getting up from a chair.

He is otherwise healthy and active.

Upon examination there is:

  • No effusion
  • Range of motion 0–120°, with mild discomfort at terminal flexion
  • Joint line tenderness medially
  • McMurray test elicits a painful click.

#1. What is the most appropriate next step in management?

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Answer: B – Arthroscopic meniscectomy or meniscal repair

This is a symptomatic bucket-handle meniscus tear with mechanical locking – a surgical indication.
Physiotherapy or injections (answers A and C) won’t address the mechanical block. A high tibial osteotomy (D) might be considered later for unicompartmental osteoarthritis with malalignment, but not here.
Total knee replacement (E) is premature. USS scan of large joints like the knee is almost never indicated and should be avoided (F).
This case highlights the importance of recognising mechanical locking as a red flag and understanding imaging findings that indicate early surgical input is warranted.

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