Unhappy triad - Medial vs Lateral Meniscus

[Phloston]

I want to get this settled once and for all:

Is the unhappy triad, in terms of the USMLE,

ACL + MCL + medial meniscus, or

ACL + MCL + lateral meniscus ?


It had shocked me, when I had done a question in USMLE Rx about two months ago, to find that the answer was lateral, not medial meniscus.

Even FA, on page 405, says lateral, not medial, meniscus.

However, note the errata for FA says medial, not lateral.

Does anyone have any thoughts on this?

http://firstaidteam.com/3527/2012-step-1-errata-posted

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[hinduthug]

Terrible triad is definitely Medial Meniscus, Medial Collateral Ligament, and ACL. Cause if you get a blow to the lateral knee you would damage the medial side...and the Medial collateral ligament is fused with Medial meniscus as it connects femur to tibia. Where as the Lateral collateral ligament is not fused with the meniscus on that side connecting from femur to fibular head.

If I am incorrect please let me know!

 

[VisionaryTics]

If the unhappy triad is the lateral meniscus, Mariano Rivera would like his medial meniscus back.

 

[johndoe3344]

Ugh. I always learned it as lateral, but I think it should be medial after seeing the latest FA errata.

(Does anyone else treat errata'd FA as being more accurate than uptodate or textbooks, or basically any other source in existence?)

 

[AndyRSC]

I'm not sure what kind of **** the people in charge of FA errata are smoking, but they have a long track record of ****ing up even more facts with their "errata" as the year goes on. The hand clawing is a prime example.

It's lateral, not medial meniscus. The medial being part of the triad is a vestige of the 1950s O'Donoghue report, which has since been shown to be statistically improbable. Lateral meniscus injuries far outnumber the medials with lateral blows. I've had this question come up in numerous qbanks. It's "ACL + MCL + lateral meniscus" every time.

https://www.ncbi.nlm.nih.gov/pubmed/1550645

 

[Phloston]

So who's right?

Are you saying the errata needs an errata?

I've seen that PubMed abstract also, and I'm sure different sources will say different things, but regardless, we just want to know what to select as the right answer on the USMLE. FA's errata makes it seem as though we should select medial. The USMLE Rx question that had lateral, not medial, as the correct answer, was of course written by the FA authors; I would believe that that question had been written before they put forth the 2012 errata. Perhaps that question was wrong then.

Any more thoughts, people?

 

[AndyRSC]

I'm saying they need to fact-check all the corrections they post, as I've watched them **** this up for as long as I've followed FA (2009-2012). It's baffling to me how the things they correct throughout the year are, once again, incorrect in the next edition. Conversely, they may correct something in a new edition, then revert correct information back to incorrect because some jackass who learned otherwise petitions for the change to be made and no one bothers to research it.

The bright young minds of tomorrow deserve better than this =)

 

[ijn]

I'd go with lateral, but I highly doubt they're going to straight up ask you what's the third part of the unhappy triad. More likely they're going to point at a knee ligament on an image and ask you to identify it.

... We conclude that the classic O'Donoghue triad is, in fact, an unusual clinical entity among athletes with knee injuries; it might be more accurately described as a triad consisting of ACL, MCL, and lateral meniscus tears. This injury combination appears to be more common when an incomplete, or second-degree, tear of the medial collateral has occurred. Third-degree MCL injuries in conjunction with ACL disruptions seem to "protect" joint surfaces, as patients with these injuries most commonly demonstrate an absence of further intraarticular abnormality (meniscal or chondral).

 

[MrBeauregard]

Ugh. I always learned it as lateral, but I think it should be medial after seeing the latest FA errata.

(Does anyone else treat errata'd FA as being more accurate than uptodate or textbooks, or basically any other source in existence?)

Absolutely not. Judging by the amount of mistakes/discrepancies Phloston has found in USMLERx, I actually treat FA as the opposite. Sometimes I find it hard to trust.

So who's right?

Are you saying the errata needs an errata?

I've seen that PubMed abstract also, and I'm sure different sources will say different things, but regardless, we just want to know what to select as the right answer on the USMLE. FA's errata makes it seem as though we should select medial. The USMLE Rx question that had lateral, not medial, as the correct answer, was of course written by the FA authors; I would believe that that question had been written before they put forth the 2012 errata. Perhaps that question was wrong then.

Any more thoughts, people?

It's lateral meniscus. As AndyRSC said, lateral meniscus injuries far outweigh those to the medial meniscus.

 

[Phloston]

I've had this question come up in numerous qbanks. It's "ACL + MCL + lateral meniscus" every time.

Where did you encounter lateral as the answer in QBanks?

As I mentioned above, although lateral was the correct answer in Rx, since Rx is written by the FA authors, their recent FA errata likely outweighs their question.

More importantly: had you encountered "lateral meniscus" in Kaplan or UWorld? What are you referring to by "numerous qbanks?"

 

[Phloston]

HOLD UP, I HAVE AN UPDATE:

As I had mentioned before, I had encountered a USMLE Rx question a couple months ago that had lateral, not medial, meniscus as the correct answer.

The FA2012 errata say medial, not lateral.

Furthermore,

I just finished the 3000 questions in the USMLE Rx QBank yesterday, and I'm running through the 400+ questions I got wrong again, and the unhappy triad question just came up, and the answer is NOW MEDIAL, NOT LATERAL. They changed it. How do I know they changed it? Because I'm 1000% sure I put medial meniscus the first time around, and had been shocked that it was lateral, as I had never heard that before.

They have 55% choosing lateral meniscus and 37% choosing medial. Medial is USMLE Rx's correct answer.

Here is a PrntScr image of USMLE Rx:

 

[AndyRSC]

That's pretty obscene.

As for which qbanks, Kaplan and ComBank. Maybe UWorld; it's been close to a year now. I do remember coming across that question a multitude of times, though, and it being lateral every time.

 

[rollelephants]

i'm almost 100% sure it's medial, because as someone above said, the MCL attaches to the medial meniscus, wheras the LCL is separated from the lateral meniscus by the popliteus. Therefore, when you get the lateral blow to the knee, you tear the MCL, which by connection/association tears the medial meniscus with it.

 

[JackShephard MD]

This seems to be an acute vs. chronic issue, according to gunnertraining and their sites:

In an acute ACL injury triad, the lateral meniscus is typically injured. In a chronic ACL injury triad, the medial meniscus is included instead.

http://emedicine.medscape.com/article/89442-overview

When matched for activities, a greater prevalence for ACL injury is found in females compared with males. Approximately 50% of patients with ACL injuries also have meniscal tears. In acute ACL injuries, the lateral meniscus is more commonly torn; in chronic ACL tears, the medial meniscus is more commonly torn. The only study on the prevalence of ACL injuries in the general population has estimated the incidence as 1 case in 3,500 people, resulting in 95,000 new ACL ruptures per year.

http://www.ncbi.nlm.nih.gov/pubmed/9728714

Patients with chronic ACL tears had a higher prevalence of medial meniscal tears (78% versus 40%), articular chondromalacia, and an increased posterior cruciate bow ratio (0.47 versus 0.37) in association with chronic ACL tears.

In patients that do develop the classic unhappy triad , only the ACL and MCL are acutely injured during the acute valgus stress on the knee, while the injury to the medial meniscus is the result of chronic injury secondary to ACL insufficiency

http://ajs.sagepub.com/content/19/5/474.abstract

We conclude that the classic O'Donoghue triad is, in fact, an unusual clinical entity among athletes with knee injuries; it might be more accurately described as a triad consisting of ACL, MCL, and lateral meniscus tears. This injury combination appears to be more common when an incomplete, or second-degree, tear of the medial collateral has occurred. Third-degree MCL injuries in conjunction with ACL disruptions seem to "protect" joint surfaces, as patients with these injuries most commonly demonstrate an absence of further intraarticular abnormality (meniscal or chondral).

First Aid Errata:

The unhappy triad consists of the MCL, ACL, and the medial (not lateral) meniscus. The MCL and medial meniscus are connected and tear together. This is how it is tested on the boards.

I would just go with the first aid errata, but it appears that the medial is secondary due to the ACL insufficieny rather than acute valgus stress, which would result in lateral meniscus tears.

 

[AndyRSC]

This seems to be an acute vs. chronic issue

Interestingly enough, Step 2 FA 2012 actually specifies that although the classic "unhappy triad" includes medial meniscus, lateral meniscal tears are commonly seen in acute ACL injuries.

 

[JackShephard MD]

i'm almost 100% sure it's medial, because as someone above said, the MCL attaches to the medial meniscus, wheras the LCL is separated from the lateral meniscus by the popliteus. Therefore, when you get the lateral blow to the knee, you tear the MCL, which by connection/association tears the medial meniscus with it.

But this isn't true, not according to the sources I was reading.

 

[onb2014]

.

 

[johndoe3344]

So on a test day, a question comes up... and describes a person playing football... having their foot planted... then getting tackled. Then they ask you which structures [of the unhappy triad] are damaged. Would that be an acute or chronic injury? I.e. are you guys going to put lateral or medial?

Because that sounds like acute, that's pretty much the only way I've heard it been asked before.

 

[Morsetlis]

I'm not sure what kind of **** the people in charge of FA errata are smoking, but they have a long track record of ****ing up even more facts with their "errata" as the year goes on. The hand clawing is a prime example.

It's lateral, not medial meniscus. The medial being part of the triad is a vestige of the 1950s O'Donoghue report, which has since been shown to be statistically improbable. Lateral meniscus injuries far outnumber the medials with lateral blows. I've had this question come up in numerous qbanks. It's "ACL + MCL + lateral meniscus" every time.

https://www.ncbi.nlm.nih.gov/pubmed/1550645

The term "hand clawing" should never ever be used. It can mean 100 different things.

 

[lrkoehle]

This seems to be an acute vs. chronic issue, according to gunnertraining and their sites:

In an acute ACL injury triad, the lateral meniscus is typically injured. In a chronic ACL injury triad, the medial meniscus is included instead.

http://emedicine.medscape.com/article/89442-overview

http://www.ncbi.nlm.nih.gov/pubmed/9728714


In patients that do develop the classic unhappy triad , only the ACL and MCL are acutely injured during the acute valgus stress on the knee, while the injury to the medial meniscus is the result of chronic injury secondary to ACL insufficiency

http://ajs.sagepub.com/content/19/5/474.abstract


First Aid Errata:



I would just go with the first aid errata, but it appears that the medial is secondary due to the ACL insufficieny rather than acute valgus stress, which would result in lateral meniscus tears.

GT FTW! To me the explanation provided by GT and it's sources make sense. I think of it like this, with an acute injury the lateral condyle of the femur is going to get smashed into the lateral meniscus as the valgus stress is applied.

With a chronic unhappy triad, the ligamentous support structure of the knee is weak over the medial tibial plateau (where the medial meniscus is), which allows the medial femoral condyle to have excess translocation on the tibial plateau leading to injury of the meniscus there.

 

[AndyRSC]

The term "hand clawing" should never ever be used. It can mean 100 different things.

Not sure if you were speaking in general or trying to school me.

I was referring, of course, to the section on clawing in FA, which edition after edition has been laden with mistakes and confusion.

 

[Phloston]

My conclusion:

Given that FA2012 errata has changed the triad from lateral to medial and USMLE Rx has changed the QBank question to medial, from lateral, on the actual USMLE, if I had to sit the exam tomorrow (thank Gd I'm not for 7.5 more months), I would answer medial.

I would put medial, not just because of FA and Rx's recent changes, but also specifically because of my thoughts as far as what the USMLE would actually be testing us on if they were to ask lateral vs medial meniscus. If the USMLE were to ask medial vs lateral meniscus, and their correct answer was in fact medial, then they would be testing our knowledge of the traditional triad model in conjunction with the anatomical relation of the ML to the MCL; if on the other hand the answer were truly lateral, not medial, then the USMLE would be testing our knowledge as to whether we're aware of some of the various studies that have demonstrated lateral occurs more frequently.

I reckon it is likely that they'd be more concerned with the former over the latter. Therefore, I believe the answer would be more likely to be medial.

 

[3dee]

The DIT guys says it could be either

 

[lrkoehle]

All this confusion makes me think it is unlikely to show up on the real thing, but if it does, I hope they would have the sense to at least include a positive medial McMurray test if they actually want medial as the correct answer choice. Of course that would probably make it too easy, so again, I think we're back to this not showing up on the real thing. Has anyone who has actually taken it seen it on their actual exam, not just Qbanks?

 

[JackShephard MD]

My conclusion:

Given that FA2012 errata has changed the triad from lateral to medial and USMLE Rx has changed the QBank question to medial, from lateral, on the actual USMLE, if I had to sit the exam tomorrow (thank Gd I'm not for 7.5 more months), I would answer medial.

I would put medial, not just because of FA and Rx's recent changes, but also specifically because of my thoughts as far as what the USMLE would actually be testing us on if they were to ask lateral vs medial meniscus. If the USMLE were to ask medial vs lateral meniscus, and their correct answer was in fact medial, then they would be testing our knowledge of the traditional triad model in conjunction with the anatomical relation of the ML to the MCL; if on the other hand the answer were truly lateral, not medial, then the USMLE would be testing our knowledge as to whether we're aware of some of the various studies that have demonstrated lateral occurs more frequently.

I reckon it is likely that they'd be more concerned with the former over the latter. Therefore, I believe the answer would be more likely to be medial.

I honestly don't know what conclusion you've come to here. That the "unhappy triad" includes medial meniscus? I guess you could say that, as it was originally defined to include it.

It's pretty clear what the concepts to know here are, that acute valgus stress will lead to damage of the lateral meniscus, while chronic ACL insufficiency will lead to medial meniscus damage, as to your conclusion, "If I were asked tomorrow..."

Asked what? Asked what happens in an acute ACL injury? You would be wrong to say medial meniscus, and there is no way that the test writers would have that be the correct answer. If you were asked what is included in the unhappy triad, sure, I guess medial is correct. Your thought process is following, "what science do the test writers want us to memorize" rather than "how is this science applied clinically".

While First Aid is the best resource and the bible, the test writers aren't (knowingly) going to put a false correct answer on the exam.

I would focus more on the concepts and reasons (i.e. clinical application) rather than knowing the definition of an unhappy triad. The term was created to understand a clinical finding. This falls into the category of memorizing lists of epithelium you asked the other day, I would just understand the concepts clinically.

The fact that First Aid for Step 2 has picked this up should make you realize this isn't obscure random research, but clinically relevant information.

 

[Phloston]

It's pretty clear what the concepts to know here are, that acute valgus stress will lead to damage of the lateral meniscus, while chronic ACL insufficiency will lead to medial meniscus damage...

JackShephard, I could almost guarantee that the USMLE would never test us on "chronic ACL insufficiency."

If they test the triad, they would want us to know that the MM and MCL are found together, not that the LM has been shown by some studies to get injured more frequently. The answer would more likely be medial, not lateral, irrespective of the PubMed sources you've perused. Therefore, I would adhere to FA2012 and USMLE Rx. If you don't read the Bible, that's okay.

This has nothing to do with memorization versus in depth clinical reasoning or understanding, although as far as the respiratory epithelium thread is concerned, the memorization of that material could be applied clinically in a myriad of ways. It might benefit you to have that list down as well.

 

[Morsetlis]

Not sure if you were speaking in general or trying to school me.

I was referring, of course, to the section on clawing in FA, which edition after edition has been laden with mistakes and confusion.

I was speaking in general, lol. I hate that word.

 

[johndoe3344]

although as far as the respiratory epithelium thread is concerned, the memorization of that material could be applied clinically in a myriad of ways. It might benefit you to have that list down as well.

I'm sure it would "benefit" all of us to have all of Uptodate memorized. In the short time that most of us are given to prepare for the Step, that's simply not practical. I could think of about a hundred things that would be more beneficial not just for Step 1, but also for rotations and real life than memorizing that list of respiratory epithelium cell types.

 

[Phloston]

I'm sure it would "benefit" all of us to have all of Uptodate memorized. In the short time that most of us are given to prepare for the Step, that's simply not practical. I could think of about a hundred things that would be more beneficial not just for Step 1, but also for rotations and real life than memorizing that list of respiratory epithelium cell types.

Then don't memorize it.

 

[JackShephard MD]

JackShephard, I could almost guarantee that the USMLE would never test us on "chronic ACL insufficiency."

If they test the triad, they would want us to know that the MM and MCL are found together, not that the LM has been shown by some studies to get injured more frequently. The answer would more likely be medial, not lateral, irrespective of the PubMed sources you've perused. Therefore, I would adhere to FA2012 and USMLE Rx. If you don't read the Bible, that's okay.

This has nothing to do with memorization versus in depth clinical reasoning or understanding, although as far as the respiratory epithelium thread is concerned, the memorization of that material could be applied clinically in a myriad of ways. It might benefit you to have that list down as well.

It's impressive you can guarantee what's on the exam.👍

Your quote:

they would want us to know that the MM and MCL are found together, not that the LM has been shown by some studies to get injured more frequently.

😕 "the MM and MCL are found together", what does that even mean? I'm sure you realize by now, the term was created because someone noticed clnically that the 3 were injured together. Well, now they know why. The acute/chronic injuries are different (understanding behind clinical findings). Wiki, Gunnertraining, First Aid for Step 2, medscape, pubmed, and anyone writing questions knows this. You won't miss a question understanding the science.

If the question is, what is the unhappy triad (little clinical significance)? MM. Chronic ACL injury (clinically significant)? MM. Acute ACL injury? LM.

If you don't read the Bible, that's okay.

😕

although as far as the respiratory epithelium thread is concerned, the memorization of that material could be applied clinically in a myriad of ways. It might benefit you to have that list down as well.

http://forums.studentdoctor.net/showthread.php?t=909183&highlight=Phloston
Respiratory epithelium list = fail.

I'm sure it would "benefit" all of us to have all of Uptodate memorized. In the short time that most of us are given to prepare for the Step, that's simply not practical. I could think of about a hundred things that would be more beneficial not just for Step 1, but also for rotations and real life than memorizing that list of respiratory epithelium cell types.

👍 I think this is why IMG scores are looked at more carefully. I've heard schools with 3-6 months off to study for step 1, while we all have 4-6 weeks.

Edit: First Aid 2011 (p. 370) had the following listed:

Common football injury. Force from the lateral
side~ damage to the "unhappy triad ":
1. Medial collateral ligament (MCL)
2. Anterior cruciate ligament (ACL)
3. Lateral (not medial) meniscus

And their errata never addressed this.
http://firstaidteam.com/wp-content/uploads/FA-Step-1-2011-errata-110817.pdf

 

[Phloston]

And their errata never addressed this.
http://firstaidteam.com/wp-content/uploads/FA-Step-1-2011-errata-110817.pdf

That's because you're looking at the 2011 errata.

Here is a link to the 2012 errata: http://firstaidteam.com/3527/2012-step-1-errata-posted

On the other hand, hopefully that squares things away. Good luck,

And yes, it is fortunate that I have more than 4-6 wks at the end of second-year to study for this exam, however I'm juggling a PhD right now, so that doesn't exactly make things a whole lot easier.

 

[VisionaryTics]

Jesus Christ, Phloston, you're not taking the exam for another 7.5 MONTHS? How in God's name do you plan on sustaining this level of nitpicky neuroticism for that long? I actually appreciate a lot of your threads, and just figured somebody worrying about so many low yield facts would be clarifying little gaps in knowledge during the final few weeks of prep.

But you actually plan on keeping this up until December!?

 

[MrBeauregard]

That's because you're looking at the 2011 errata.

Here is a link to the 2012 errata: http://firstaidteam.com/3527/2012-step-1-errata-posted

On the other hand, hopefully that squares things away. Good luck,

And yes, it is fortunate that I have more than 4-6 wks at the end of second-year to study for this exam, however I'm juggling a PhD right now, so that doesn't exactly make things a whole lot easier.

That's the point, though. The 2011 errata never addressed the fact that LM was listed as correct and not MM. Now that 2012 is out, the errata states that LM is not correct and rather MM is correct. Sometimes I just find it tough to trust FA completely.

 

[MrBeauregard]

Jesus Christ, Phloston, you're not taking the exam for another 7.5 MONTHS? How in God's name do you plan on sustaining this level of nitpicky neuroticism for that long? I actually appreciate a lot of your threads, and just figured somebody worrying about so many low yield facts would be clarifying little gaps in knowledge during the final few weeks of prep.

But you actually plan on keeping this up until December!?

No lie. The dude is obviously going to kill it and I appreciate the threads he creates to clear some things up, but he can be nitpicky. I guess that's what you'd expect out of a PhD candidate, thought. 😛

Keep up the good work, Phloston.

 

[Phloston]

Jesus Christ, Phloston, you're not taking the exam for another 7.5 MONTHS? How in God's name do you plan on sustaining this level of nitpicky neuroticism for that long? I actually appreciate a lot of your threads, and just figured somebody worrying about so many low yield facts would be clarifying little gaps in knowledge during the final few weeks of prep.

But you actually plan on keeping this up until December!?

I just want to be sure that I've gone through Rx, Kaplan and UWorld all twice, and that I've also gone through Kaplan QBook and FA Q&A both once. Fortunately, I've already gotten the Utah Webpath and Robbins RR questions out of the way. Do I think that guarantees me a great score? Of course not. But I do just want to be able to go through the exam day and feel like I've "seen" everything before.

 

[SteinUmStein]

I just want to be sure that I've gone through Rx, Kaplan and UWorld all twice, and that I've also gone through Kaplan QBook and FA Q&A both once. Fortunately, I've already gotten the Utah Webpath and Robbins RR questions out of the way. Do I think that guarantees me a great score? Of course not. But I do just want to be able to go through the exam day and feel like I've "seen" everything before.

Mad props to you, because I think I'd rather drop out of med school than do what you're doing. Best of luck though, you'll do awesome. 👍

 

[theRainmaker78]

Mad props to you 👍

👍

At least Phlosten, and some of the other frequent posters like Shan, keep the step 1 forum interesting.

And I had been convinced it was lateral but now I am truly confused..... But thanks for the heads up

 

[RedSoxSuck]

I just want to be sure that I've gone through Rx, Kaplan and UWorld all twice, and that I've also gone through Kaplan QBook and FA Q&A both once. Fortunately, I've already gotten the Utah Webpath and Robbins RR questions out of the way. Do I think that guarantees me a great score? Of course not. But I do just want to be able to go through the exam day and feel like I've "seen" everything before.

This post made me depress because i feel like i need to find more hours in a day to do more. Damn you SDN.

 

[RedSoxSuck]

I just want to be sure that I've gone through Rx, Kaplan and UWorld all twice, and that I've also gone through Kaplan QBook and FA Q&A both once. Fortunately, I've already gotten the Utah Webpath and Robbins RR questions out of the way. Do I think that guarantees me a great score? Of course not. But I do just want to be able to go through the exam day and feel like I've "seen" everything before.

All kidding aside, what can i do to be smart like you?

 

[JackShephard MD]

...

 

[Jarrodmac10]

I believe valgus forces to the lateral compartment of the knee disrupt the integrity of the medial meniscus. It makes sense to me that MM is the correct answer, because we know the MCL is ruptured in the unhappy triad (due to valgus forces), and since the MCL is fused with the MM it makes sense that the MM would tear along with the MCL. Yes?

 

[newtonsfriend]

This exact question actually came up in my class when we did the MSK block and the orthopedic giving the lecture said that the "classic" unhappy triad is: MCL, medial meniscus, and ACL. He said a pubmed article came out showing that the lateral meniscus may in fact be more common to injure with the ACL/MCL, but he followed that up by saying "currently most orthopedists still believe the classic definition of the unhappy triad." I would be surprised if they asked a question about this. He is also on the committee for writing questions for the MSK block of USMLE if that matters.... bc there are hundreds of others as well.

 

[DrDJShik]

HOLD UP, I HAVE AN UPDATE:

As I had mentioned before, I had encountered a USMLE Rx question a couple months ago that had lateral, not medial, meniscus as the correct answer.

The FA2012 errata say medial, not lateral.

Furthermore,

I just finished the 3000 questions in the USMLE Rx QBank yesterday, and I'm running through the 400+ questions I got wrong again, and the unhappy triad question just came up, and the answer is NOW MEDIAL, NOT LATERAL. They changed it. How do I know they changed it? Because I'm 1000% sure I put medial meniscus the first time around, and had been shocked that it was lateral, as I had never heard that before.

They have 55% choosing lateral meniscus and 37% choosing medial. Medial is USMLE Rx's correct answer.

Here is a PrntScr image of USMLE Rx:

HAHA ME TOO! I just had this second one come up and they said MEDIAL! Lateral was an answer on the last one I had...I bitched them out in the feedback.

 

[shan564]

In DIT, they said that it's lateral in 56% of cases and medial in 44% of cases. I haven't looked it up to confirm, but with numbers that specific, I'll take their word for it. They also have a pretty good track record of pointing out mistakes and sub-optimal phrasing in First Aid.

Based on that, I'm assuming that they won't ask us which one is more likely on Step 1. It's more likely that they'll ask which cruciate or which collateral is likely to be torn. I've never seen a UW question that asked us to specify the correct meniscus.

 

[Phloston]

Now, by all means, we're all very sick of triad topic at this point, but I just thought I should throw in that I was at a Shabbat dinner last night, and the guy holding it was an orthopedic surgeon specializing in knees! So I asked him about the triad and whether it was lateral vs medial meniscus, and his eyes lit up (implying he had dealt with this dilemma/debate before) and he said that O'Donoghue did a study years ago saying medial, but that in his practice, for ACUTE injury, he almost exclusively sees lateral. He then said (I didn't even ask him about chronic vs acute) that he tends to see medial meniscus injuries in people with chronic knee problems.

Once again, I'm not trying to stir up the argument again. We're all up in the air about whether the USMLE would actually want one vs the other, but given the specific relevance of that conversation I had had, I thought I'd share.

 

[JackShephard MD]

Now, by all means, we're all very sick of triad topic at this point, but I just thought I should throw in that I was at a Shabbat dinner last night, and the guy holding it was an orthopedic surgeon specializing in knees! So I asked him about the triad and whether it was lateral vs medial meniscus, and his eyes lit up (implying he had dealt with this dilemma/debate before) and he said that O'Donoghue did a study years ago saying medial, but that in his practice, for ACUTE injury, he almost exclusively sees lateral. He then said (I didn't even ask him about chronic vs acute) that he tends to see medial meniscus injuries in people with chronic knee problems.

Once again, I'm not trying to stir up the argument again. We're all up in the air about whether the USMLE would actually want one vs the other, but given the specific relevance of that conversation I had had, I thought I'd share.

Lol. Word for word my first post (#14) in this thread.

 

[Phloston]

Lol. Word for word my first post (#14) in this thread.

👍 Good job on this one, JackShephard.

The thing is, when FA errata says "medial (this is how it's tested on boards)," that's obviously going to create a stir.

 

[Goober11]

Sorry for the necrobump but after running through 4 questions regarding this topic in Rx today I would like to see it revisited, just for a moment. I have seen plenty of evidence that acute: ACL-MCL-LM and chronic: ACL-MCL-MM. However, lets be practical here. At this point, it's about performing well on exams not real medicine.

Has anyone had any EXPERIENCE on the real deal, NBMEs, other Qbanks regarding the unhappy triad?

If not, then may this thread forever RIP.

 

[JShephard]

Adsons test is for............
Cozens Test is for...............
Apprehension Test is for..............

No.

 

[g8orlife]

No.

Seconded.