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Acute meniscal tear of the knee N067

Document
Last amended 
31 March 2016
Current RMA Instruments:
Reasonable Hypothesis SOP
55 of 2010
Balance of Probabilities SOP
56 of 2010
Changes from previous Instruments:

SOP Bulletin 144

ICD Coding:
  • ICD-9-CM Codes: 836.0,836.
  • ICD-10-AM Codes: S83.2.
Brief description

This condition is an acute tear of meniscal cartilage of the knee.  There are two menisci in each knee that are shaped in the form of a crescent or half moon (semilunar).

Meniscal tears are described with reference to their appearance as bucket handle; longitudinal; radial; horizontal; vertical; oblique; transverse; flap; parrot beak, etc.

Acute meniscal tears either become asymptomatic over a period of several months or persist with symptoms.  A chronic (non-degenerative) meniscal tear is covered by the SOP for internal derangement of the knee.   

Confirming the diagnosis

This diagnosis is made at arthroscopy or on CT scan or MRI scan.  This diagnosis cannot reliably be made clinically or on the basis of a plain X-ray or nuclear bone scan.  Note also that reported MRI signal change in the meniscus without a discrete tear to the articular surface is not considered as a reliable indication of a meniscal tear given the high incidence of false positives.

The relevant medical specialist is an orthopaedic surgeon.

Additional diagnoses that are covered by SOP
  • Nil
Additional diagnoses that may be covered by SOP
  • Meniscal cyst where the cyst is physically located close to the site of the meniscal tear.
Conditions that are excluded from SOP
  • Acute articular cartilage tear*
  • Chronic meniscal tear* - internal derangement of the knee SOP
  • Congenital defects#
  • Degenerative meniscal tears, ICD code 715 (osteoarthritis), N.I.F. (No Incapacity Found), or 717.5 (non-SOP).
  • Discoid meniscus#
  • Internal derangement of the knee*
  • Capsule tear; ligament tear; muscle tear; or tendon tear* - sprain and strain SOP
  • Meniscal pseudo tears#
  • Osteoarthritis*
  • Plica, N.I.F.
  • Radiological findings such as MRI signal change in the meniscus without a discrete tear to the articular surface.  These findings have a high incidence of false positives when later investigated by arthroscopy which is considered as the ‘gold standard’ for diagnosis of meniscal tears.

* another SOP applies

# non-SOP condition

Clinical onset

Clinical onset will be at the time of the sudden onset of knee pain, associated with injury or physical activity, that is subsequently found to be due to acute mensical tear.

Clinical worsening

The only SOP worsening factor is for inability to obtain appropriate clinical management.