A college football player repos knee pain along the medial joint line with intermittent locking and inability to fully extend the knee after a twisting injury to his right knee. He has a negative Lachman test and a positive McMurray test. What is the most likely diagnosis
**Core Concept**
The patient's symptoms suggest a meniscal injury, specifically a meniscal tear, given the history of twisting injury and the positive McMurray test. Meniscal tears are common in young, athletic individuals, and the McMurray test is a specific maneuver used to elicit the classic "clunk" associated with meniscal displacement.
**Why the Correct Answer is Right**
The McMurray test is performed by flexing the knee to 90 degrees, then fully extending it while applying pressure to the joint line. A positive test is indicated by a palpable "clunk" or a sudden change in the patient's expression, which is often described as a feeling of "something going out." This is due to the displacement of a torn meniscus from its normal position within the knee joint. Meniscal tears can cause locking or catching sensations as the torn meniscal fragment catches on the surrounding bone or ligaments, leading to the patient's inability to fully extend the knee.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because a medial meniscal tear would more likely be associated with a positive Apley test, not a negative Lachman test. The Lachman test is used to assess anterior cruciate ligament (ACL) integrity.
**Option B:** This option is incorrect because a medial collateral ligament (MCL) injury would not typically cause locking or an inability to fully extend the knee. MCL injuries are more often associated with valgus stress and pain along the medial joint line.
**Option C:** This option is incorrect because a patellofemoral syndrome would not typically cause locking or an inability to fully extend the knee. Patellofemoral syndrome is associated with anterior knee pain and discomfort, often exacerbated by activities that involve bending or squatting.
**Clinical Pearl / High-Yield Fact**
A positive McMurray test in the setting of a twisting injury and locking or catching sensations should raise suspicion for a meniscal tear. The test is highly specific for meniscal pathology and should be performed in conjunction with other diagnostic tests, such as radiographs and MRI, to confirm the diagnosis.
**Correct Answer:** C.