Manual Tibial Distraction in Seated Position for Identification of Intra-articular Knee Joint Lesions: A Case Report Presenting a Novel Clinical Special Test.

The meniscus is a weight-bearing, intra-articular, fibrocartilaginous structure that is frequently injured. Traditional special tests for diagnosis of intra-articular lesions of the knee involve provocative tests with compressive or torsional components, often leading to increased pain. With this case study, we aim to introduce the Tibial Distraction Test (TDT), a novel clinical special test for the assessment of intra-articular knee joint lesions, including meniscus injury and osteoarthritis (OA), without provoking pain. A 30-year-old man presented to the clinic with right knee pain and swelling of two months duration following a forceful extension and internal rotation motion which led to a catch then audible pop and discomfort. The patient's initial assessment included McMurray's test, joint line palpation, and Apley's compression tests with positive results for each test. A second examiner, blinded to the initial examination, assessed the patient using the proposed TDT. The patient reported pain relief, indicating a positive result. Subsequent magnetic resonance imaging (MRI) confirmed the diagnosis of a medial meniscus tear. Arthroscopy showed a full-thickness meniscal tear and debridement was performed. At one month's follow-up, the patient returned to baseline function with resolution of symptoms. Diagnosing intra-articular lesions of the knee requires a thorough history and examination, frequently including painful provocative clinical special tests in a patient already presenting with pain as a primary complaint. Our case presents a novel manual clinical special test in a seated position which appears to be a pain-relieving test that may be used to assess for intra-articular knee joint lesions.