Surgical Trends in the Treatment of Meniscal Tears

Parker, Benjamin R.; Hurwitz, Shepard R.; Spang, Jeffrey T.; Creighton, R. Alexander; Kamath, Ganesh V.

doi:10.1177/0363546516638082

Cited by 84 publications

(17 citation statements)

References 21 publications

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“…Previous studies in the US have reported an increasing number of meniscus repairs performed at the same time as ACL reconstructions. [ 48 , 49 ] This is not surprising given the increased education in the recent years regarding the chondroprotective effects of meniscus preservation. [ 49 ] Conversely, in a study conducted in Brazil, Astur et al[ 50 ] demonstrated that less than 2% of knee surgeons in both public and private health care systems routinely perform meniscal repair at the same time as ACLR.…”

Section: Discussionmentioning

confidence: 99%

Analysis of 500 anterior cruciate ligament reconstructions from a private institutional register

et al. 2018

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PurposeThe aims of this study are to describe the epidemiological characteristics of anterior cruciate ligament reconstructions in a private hospital in Brazil and to determine trends in medical practice for comparison with previous studies.MethodsWe retrospectively reviewed the anterior cruciate ligament institutional register to obtain data from all patients who underwent primary anterior cruciate ligament reconstruction from July 2014 to June 2016. Descriptive statistics were used to summarize the sample. Specific statistical tests were used to assess associations between the meniscal lesion and other variables.ResultsDuring the study period, 72.6% out of 500 patients were male. The mean age at surgery was 35.1 years. The mean age was higher among females than among males (37.3 ± 12.1 vs 34.3 ± 10.8 years). The median time from injury to surgery was 44 days. The most common femoral and tibial fixations used were suspensory fixation (60.8%) and interference screw (96%), respectively. The most commonly used graft was hamstring tendon (70.2%), followed by bone-patellar tendon-bone (28.8%). A meniscal lesion was noted in 44.8% of cases. Partial meniscectomy was performed in 69.5% of meniscal lesions, and meniscal repair was performed in 14.1% of lesions. The mean length of hospital stay was 1.4 days. The proportion of men in the group of patients with an associated meniscal lesion was higher than that in the group of patients without a meniscal lesion (p = 0.007).ConclusionsIn this study, we identified that the vast majority of surgeries were performed in male patients in all age groups, and patients older than 30 years and with a short time from injury to surgery predominated. Concerning surgical technique, we noted a low rate of meniscal repair and a higher preference for the use of hamstring graft and suspensory fixation on the femoral side.

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Section: Discussionmentioning

confidence: 99%

Analysis of 500 anterior cruciate ligament reconstructions from a private institutional register

et al. 2018

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“…As stated above, the physiotherapist had access only to the ME without imaging to make the triage recommendation. Recent evidence proposes that pain, functional limitations and clinical symptoms should be used as surgical eligibility criteria for ACL injuries [ 45 ], meniscal injuries [ 46 , 47 ] and knee OA [ 48 , 49 ] and not systematically rely on imaging results. In our study, 82% (116/142) of secondary care participants and 92% (34/37) of primary care participants were referred to conservative care after their first consultation.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic validity and triage concordance of a physiotherapist compared to physicians’ diagnoses for common knee disorders

Décary

Fallaha

Pelletier

et al. 2017

BMC Musculoskelet Disord

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BackgroundEmergence of more autonomous roles for physiotherapists warrants more evidence regarding their diagnostic capabilities. Therefore, we aimed to evaluate diagnostic and surgical triage concordance between a physiotherapist and expert physicians and to assess the diagnostic validity of the physiotherapist’s musculoskeletal examination (ME) without imaging.MethodsThis is a prospective diagnostic study where 179 consecutive participants consulting for any knee complaint were independently diagnosed and triaged by two evaluators: a physiotherapist and one expert physician (orthopaedic surgeons or sport medicine physicians). The physiotherapist completed only a ME, while the physicians also had access to imaging to make their diagnosis. Raw agreement proportions and Cohen’s kappa (k) were calculated to assess inter-rater agreement. Sensitivity (Se) and specificity (Sp), as well as positive and negative likelihood ratios (LR+/−) were calculated to assess the validity of the ME compared to the physicians’ composite diagnosis.ResultsPrimary knee diagnoses included anterior cruciate ligament injury (n = 8), meniscal injury (n = 36), patellofemoral pain (n = 45) and osteoarthritis (n = 79). Diagnostic inter-rater agreement between the physiotherapist and physicians was high (k = 0.89; 95% CI:0.83–0.94). Inter-rater agreement for triage recommendations of surgical candidates was good (k = 0.73; 95% CI:0.60–0.86). Se and Sp of the physiotherapist’s ME ranged from 82.0 to 100.0% and 96.0 to 100.0% respectively and LR+/− ranged from 23.2 to 30.5 and from 0.03 to 0.09 respectively.ConclusionsThere was high diagnostic agreement and good triage concordance between the physiotherapist and physicians. The ME without imaging may be sufficient to diagnose or exclude common knee disorders for a large proportion of patients. Replication in a larger study will be required as well as further assessment of innovative multidisciplinary care trajectories to improve care of patients with common musculoskeletal disorders.Electronic supplementary materialThe online version of this article (10.1186/s12891-017-1799-3) contains supplementary material, which is available to authorized users.

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“…Nationwide studies of trends in meniscectomy and meniscus repair illuminate how the clinical evidence base influences the selection of surgical techniques. Three previous studies from the United States showed divergent trends in arthroscopic meniscus surgery; one of them reported a decrease in cases of meniscectomy per surgeons [ 31 ], while the other two showed that the incidence of meniscectomy was stable or increasing [ 16 , 32 ]. As for meniscus repair, two of them reported an increase in meniscus repair [ 16 , 31 ], but the proportion undergoing meniscus repair was still substantially lower than meniscectomy, even among young patients [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Annual trends in arthroscopic meniscus surgery: Analysis of a national database in Japan

et al. 2018

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BackgroundThe importance of meniscus preservation is widely recognized. There have been a few studies describing trends in meniscectomy and meniscus repair in the United States; however, they presented differing results. We reported annual trends in meniscus surgery, using a national database in Japan.MethodsWe interrogated the Diagnosis Procedure Combination database, which represents approximately half of all hospital admissions in Japan. We included the patients who underwent meniscectomy and meniscus repair between July 2007 and March 2015. The diagnosis, age and sex of each patient were recorded.ResultsWe identified 83,105 patients: 69,310 underwent meniscectomy; 13,416 underwent meniscus repair and 379 underwent both in a single admission. The proportion of patients undergoing meniscus repair rose from 7.0% in 2007 to 25.9% in 2014 (p < 0.001), while the proportion undergoing meniscectomy fell from 92.8% in 2007 to 73.3% in 2014 (p < 0.001). Among patients under 30 years old, the proportions undergoing meniscus repair or meniscectomy in 2014 were 50.3% versus 48.3%, respectively. A bimodal age distribution was observed for meniscectomy, with peaks at 10–19 years of age and 60–69 years of age, whereas most patients undergoing meniscus repair were 10–19 years of age.ConclusionsWe found characteristic trends where the popularity of meniscus repair increased rapidly at the expense of meniscectomy in Japan during the study period. In the last survey year, the proportion of meniscus repair exceeded that of meniscectomy in those younger than 30 years. Meniscectomy was undertaken most often in adolescents and early old age, while meniscus repair was undertaken most often in adolescents.

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Surgical Trends in the Treatment of Meniscal Tears

Cited by 84 publications

References 21 publications

Analysis of 500 anterior cruciate ligament reconstructions from a private institutional register

Analysis of 500 anterior cruciate ligament reconstructions from a private institutional register

Diagnostic validity and triage concordance of a physiotherapist compared to physicians’ diagnoses for common knee disorders

Annual trends in arthroscopic meniscus surgery: Analysis of a national database in Japan

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