The knee meniscus: management of traumatic tears and degenerative lesions

Abstract

Meniscectomy is one of the most popular orthopaedic procedures, but long-term results are not entirely satisfactory and the concept of meniscal preservation has therefore progressed over the years. However, the meniscectomy rate remains too high even though robust scientific publications indicate the value of meniscal repair or non-removal in traumatic tears and non-operative treatment rather than meniscectomy in degenerative meniscal lesionsIn traumatic tears, the first-line choice is repair or non-removal. Longitudinal vertical tears are a proper indication for repair, especially in the red-white or red-red zones. Success rate is high and cartilage preservation has been proven. Non-removal can be discussed for stable asymptomatic lateral meniscal tears in conjunction with anterior cruciate ligament (ACL) reconstruction. Extended indications are now recommended for some specific conditions: horizontal cleavage tears in young athletes, hidden posterior capsulo-meniscal tears in ACL injuries, radial tears and root tears.Degenerative meniscal lesions are very common findings which can be considered as an early stage of osteoarthritis in middle-aged patients. Recent randomised studies found that arthroscopic partial meniscectomy (APM) has no superiority over non-operative treatment. Thus, non-operative treatment should be the first-line choice and APM should be considered in case of failure: three months has been accepted as a threshold in the ESSKA Meniscus Consensus Project presented in 2016. Earlier indications may be proposed in cases with considerable mechanical symptoms.The main message remains: save the meniscus!Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.160056. Originally published online at www.efortopenreviews.org

Time-sensitive ambulatory orthopaedic soft-tissue surgery paradigms during the COVID-19 pandemic

“…Meniscal injuries can cause debilitating pain, instability, locking, and stiffness in patients when occurring in isolation or together with other knee pathologies. Early repair (< 3 months) for traumatic meniscal injuries was associated with reduced pain, locking, catching symptoms, and need for subsequent surgical procedures [46,47].…”

The Postoperative Meniscus: Anatomical, Operative, and Imaging Considerations

“…79 Because the load-bearing and stabilization functions of the meniscus are preserved with horizontal tears, they are incidental/asymptomatic findings in up to 60% of cases. 80 Symptomatic horizontal tears in the elderly population historically were managed with partial meniscectomy. However, partial meniscectomy decreases the meniscal surface area, increasing contact with the articular cartilage, and may accelerate osteoarthritic changes.…”

“…81,82 However, a rare subset of horizontal cleavage tears occurs in young athletes, likely of overuse or posttraumatic etiology. 80 Treatment recommendations for this subgroup differ dramatically from their degenerative counterparts and include partial meniscectomy and repair. Meniscectomy allows for a quicker return to play with less postoperative physical therapy.…”

Early Functional Rehabilitation after Meniscus Surgery: Are Currently Used Orthopedic Rehabilitation Standards Up to Date?

“…For this reason, there is a consensus to preserve or restore as much meniscus tissue as possible [2,3,12]. Due to the low intrinsic regenerative potential of meniscus tissue, however, indications for reparative procedures such as meniscus repair in terms of suturing or meniscus replacement are limited [2,3].…”