Degenerative meniscus tears are common as people age, yet there’s controversy about what the most effective treatment is, in particular whether arthroscopic surgery is beneficial. Twenty international experts, including K. Donald Shelbourne, MD, an orthopedic surgeon at Shelbourne Knee Center, provided input on an evidence-based, expert consensus statement with recommendations for the treatment of degenerative meniscus tears, published in Arthroscopy: The Journal of Arthroscopic & Related Surgery (February 2020).1 The full consensus statement is available online for free until March 21, 2020.
All panel members were fellowship trained in orthopedic sports medicine and work in academic teaching hospitals or university-based hospitals. Most panel members (14) are from North America; two are in Australia, and one member each is in Germany, Japan, Spain and South Africa.
Consensus Statement Methods
A steering group comprised of four experienced researchers used Delphi panel methodology to develop the expert consensus statement. Dr. Shelbourne and the other panel members answered 10 open-ended questions in rounds 1 and 2, followed by responding to a Likert-style questionnaire in round 3. In round 4, researchers contacted the panel members who were outside the consensus to ask them to either change their score in view of the group's response or argue their case. After round 4, 80% of the panelists agreed.
Characteristics and Diagnosis of Degenerative Meniscus Tears
All members of the panel agreed that degenerative meniscus tears are a physiological part of aging with an insidious onset. Degenerative meniscus tears mainly occur in the middle and posterior thirds of the meniscus and are often multiplanar. They do not always cause symptoms but displaced flap tears and bucket-handle tears do cause symptoms.
There was also 100% agreement that clinical examination with radiographs should be used for diagnosis. At least 90% of the panel said the radiographs should be weightbearing.
Panel Recommends Conservative Treatment First
Initial treatment for degenerative meniscus tears should be nonsurgical and platelet-rich plasma is not a good option, according to 90-100% of the panel. If the patient has true mechanical symptoms, however, 35% of the panel believed that surgery is indicated. Between 90% and 100% of the panel agreed that repairable and peripheral tears should be repaired. The entire panel agreed that surgery is indicated if pain and effusion persist and patients have failed conservative treatment for >3 months.
Arthroscopic partial meniscectomy is the preferred type of surgery. The outcome is variable and often poor, agreed all members of the panel. The majority of patients have significant decreases in pain after surgery, however, the functional outcome is variable. Concomitant chondral defects should be treated with debridement of loose fragments, not micro-fracturing.
Likely Surgical Outcomes
Patient selection for surgery is key. Poor outcomes are more likely in patients who:
- Have more severe osteoarthritis
- Are obese
- Have malalignment
- Have root tears.
Better outcomes are likely in patients who:
- Have flap tears
- Are age 50 or younger
- Have short-term symptoms.
Panel Urges Caution About Current Evidence
Seventy percent of the panel agreed that the current evidence about whether degenerative meniscus tears benefit from surgery should be viewed with caution. Results of a recent systematic review strongly suggest that meaningful conclusions cannot be drawn due to high risk of bias, studies of weak to moderate quality and small sample sizes, and diverse study characteristics.2
For more information about treatment of degenerative meniscus tears at Shelbourne Knee Center, call 888-FIX-KNEE.
References
- Hohmann, Angelo, Arciero, Bach, et al. Degenerative Meniscus Lesions: An Expert Consensus Statement Using the Modified Delphi Technique. Arthroscopy: The Journal of Arthroscopic & Related Surgery. February 2020: 36(2): 501-512.
- E. Hohmann, V. Glatt, K. Tetsworth, M. Cote. Arthroscopic partial meniscectomy or physical therapy for degenerative meniscus lesions. How robust is the current evidence? A critical systematic review and qualitative synthesis. Arthroscopy, 34 (2018), pp. 2699-2708.