{
  "schema_version": 1,
  "kind": "condition",
  "id": "meniscus-tear",
  "name": "Meniscal Tear",
  "category": "chronic",
  "sources": "AAOS Clinical Practice Guideline on Management of Osteoarthritis of the Knee / Meniscal Tears 2021 · Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639) · Depo-Medrone with Lidocaine SmPC section 4.2 (eMC product 1081) · Paracetamol 500 mg Tablets SmPC section 4.2 (eMC product 5164)",
  "review_status": "reviewed",
  "verified_against": "Paracetamol 500 mg Tablets SmPC section 4.2 (eMC product 5164) · Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639) · Depo-Medrone with Lidocaine SmPC section 4.2 (eMC product 1081) · Knee Meniscal Tears - disease-level clinical article (meniscus-tear-clinical.txt) · MSF Essential Drugs 2024 - paracetamol (oral)",
  "verified_date": "2026-08",
  "treatments": [
    {
      "id": 1184,
      "generic": "Paracetamol",
      "line": 1,
      "is_adjunct": false,
      "form": "oral.solid",
      "strength_mg": 500.0,
      "adult_dose": "1 g 3 or 4 times daily (max. 4 g daily) for knee pain",
      "adult_duration": "1-2 weeks PRN",
      "dose_source": "MSF Essential Drugs 2024 - paracetamol (oral)",
      "rationale": "Simple analgesic used as first-line pain control within conservative management (rest, physiotherapy) of a meniscal tear.",
      "cautions": [
        "Conservative initial treatment (PRICE, quadriceps strengthening physiotherapy, analgesia) is first-line for degenerative tears.",
        "Locked knee (mechanical extension block from bucket-handle tear) requires urgent orthopedic referral for arthroscopy.",
        "Do not exceed 4000 mg daily.",
        "500 mg is the per-dose ceiling used here for a child. 1000 mg is the adult dose and does not belong in a weight calculation - the daily 60 mg/kg limit is the one that binds first in any case."
      ],
      "peds_mgkg_low": 10.0,
      "peds_mgkg_high": 15.0,
      "peds_max_mg": 500.0,
      "peds_basis": "dose",
      "peds_unit": "mg",
      "peds_note": "Child 1 month and over: 15 mg/kg 3 or 4 times daily (max. 60 mg/kg daily). Child under 1 month: 10 mg/kg 3 or 4 times daily (max. 40 mg/kg daily). Below about 33 kg use a paediatric paracetamol suspension - the 500 mg tablet is not for that weight. Pediatric/adolescent meniscal tears require urgent orthopedic evaluation for repair.",
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": null,
      "peds_doses": [
        {
          "weight_kg": 10,
          "low_mg": 100,
          "high_mg": 150,
          "capped": false
        },
        {
          "weight_kg": 20,
          "low_mg": 200,
          "high_mg": 300,
          "capped": false
        },
        {
          "weight_kg": 30,
          "low_mg": 300,
          "high_mg": 450,
          "capped": false
        },
        {
          "weight_kg": 40,
          "low_mg": 400,
          "high_mg": 500,
          "capped": true
        }
      ],
      "brands": [
        {
          "trade_name": "FEBRIMOL 500 MG 20 TAB.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "PHARCO",
          "price_egp": 3.5,
          "pack_count": 20,
          "unit_price": 0.17,
          "strength_mg": 500.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "CETAMOL 500 MG 20 TABS.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "MEMPHIS",
          "price_egp": 8.0,
          "pack_count": 20,
          "unit_price": 0.4,
          "strength_mg": 500.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "PARACETAMOL-MUP 500MG B.P. 20 TABS.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "MUP",
          "price_egp": 13.0,
          "pack_count": 20,
          "unit_price": 0.65,
          "strength_mg": 500.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "CETAL 500 MG 20 TABS.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "EIPICO",
          "price_egp": 24.0,
          "pack_count": 20,
          "unit_price": 1.2,
          "strength_mg": 500.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "ARKADOLOW 500 MG 30 F.C. TABS.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "UTOPIA",
          "price_egp": 42.0,
          "pack_count": 30,
          "unit_price": 1.4,
          "strength_mg": 500.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "PARAMOL 500MG 20 TAB.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "MISR",
          "price_egp": 38.0,
          "pack_count": 20,
          "unit_price": 1.9,
          "strength_mg": 500.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "ADOL 500MG 24 CAPLETS",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "JULPHAR",
          "price_egp": 32.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 500.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "AUGICETAMIDE 500 MG 20 SACHETS",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "AUG PHARMA",
          "price_egp": 50.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 500.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "FEBRIMOL ORAL DROPS 20 ML",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "PHARCO",
          "price_egp": 4.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": null,
          "exact_strength": false,
          "exact_form": false,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "THERA-LO 3.2G/100ML ORAL SUSP. 100 ML",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "PHAROPHARMA",
          "price_egp": 5.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 3200.0,
          "exact_strength": false,
          "exact_form": false,
          "discontinued": false,
          "also_contains": null
        }
      ],
      "condition_id": "meniscus-tear"
    },
    {
      "id": 1187,
      "generic": "Referral & safety-netting (no drug therapy)",
      "line": 1,
      "is_adjunct": false,
      "form": null,
      "strength_mg": null,
      "adult_dose": null,
      "adult_duration": null,
      "dose_source": "Knee Meniscal Tears - disease-level clinical article (meniscus-tear-clinical.txt)",
      "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.",
      "cautions": [
        "RED FLAG - Referral criterion: persistent pain, swelling, or mechanical symptoms despite conservative management should be assessed for surgery."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": null,
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": null,
      "peds_doses": null,
      "brands": [],
      "condition_id": "meniscus-tear"
    },
    {
      "id": 1186,
      "generic": "Methylprednisolone",
      "line": 2,
      "is_adjunct": false,
      "form": "injection",
      "strength_mg": 40.0,
      "adult_dose": "20 to 80 mg (0.5 to 2 ml) for a large joint such as the knee",
      "adult_duration": "Single intra-articular injection",
      "dose_source": "Depo-Medrone with Lidocaine SmPC section 4.2 (eMC product 1081)",
      "rationale": "Provides short-term anti-inflammatory relief in degenerative meniscal tears associated with knee osteoarthritis.",
      "cautions": [
        "Strict aseptic technique required to prevent septic arthritis.",
        "Limit frequency to max 3-4 intra-articular injections per year into the knee to avoid articular cartilage degeneration.",
        "Contraindicated in systemic infection unless treated; avoid local injection into a previously infected joint."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "Not recommended in pediatric traumatic meniscal tears.",
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": null,
      "peds_doses": null,
      "brands": [
        {
          "trade_name": "M.P.A 40MG/ML VIAL",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "AMOUN",
          "price_egp": 8.5,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 40.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "EPIZOLONE-DEPOT 40MG/ML 1 ML I.M. VIAL",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "EIPICO",
          "price_egp": 39.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 40.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        }
      ],
      "condition_id": "meniscus-tear"
    },
    {
      "id": 1185,
      "generic": "Naproxen",
      "line": 1,
      "is_adjunct": true,
      "form": "oral.solid",
      "strength_mg": 500.0,
      "adult_dose": "250-500 mg twice daily after food for 7-14 days during acute pain flares",
      "adult_duration": "7-14 days",
      "dose_source": "Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639)",
      "rationale": "NSAID added to paracetamol and conservative measures for flares of inflammatory pain, not a replacement for the physiotherapy-led conservative approach that remains first-line for degenerative tears.",
      "cautions": [
        "Take with food; GI co-protection (PPI) advised in elderly or high-risk patients.",
        "Contraindicated in severe renal impairment, active GI ulcer, or late pregnancy.",
        "The weight fields are empty on purpose. The note already says naproxen is not for under-16s in this indication, but the numbers stayed behind it and the calculator went on drawing a dose for a 10 kg child. A withdrawn drug must not still have a working dose card."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "Not recommended under 16 years for this indication - the product label restricts paediatric naproxen to juvenile idiopathic arthritis (10 mg/kg/day in two divided doses, child over 5 years). Use paracetamol or ibuprofen instead.",
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": null,
      "peds_doses": null,
      "brands": [
        {
          "trade_name": "ORGOPROXEN 500 MG 20 TAB.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "ORGANOPHARMA > ORGANO",
          "price_egp": 16.0,
          "pack_count": 20,
          "unit_price": 0.8,
          "strength_mg": 500.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "NAPROSYN 500 MG 10 TAB.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "MISR > F.HOFFMAN LA ROCHE",
          "price_egp": 8.05,
          "pack_count": 10,
          "unit_price": 0.81,
          "strength_mg": 500.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "NAPROFEN 500MG 10 TAB.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "EL NILE.",
          "price_egp": 12.0,
          "pack_count": 10,
          "unit_price": 1.2,
          "strength_mg": 500.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "NAPROFEN 500MG 20 TAB.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "EL NILE.",
          "price_egp": 24.0,
          "pack_count": 20,
          "unit_price": 1.2,
          "strength_mg": 500.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        }
      ],
      "condition_id": "meniscus-tear"
    }
  ]
}