R Becker1, M Bernard2, S Scheffler3, S Kopf4. 1. Zentrum für Orthopädie und Unfallchirurgie, Hochschulklinikum Brandenburg, Medizinische Hochschule Theodor Fontane, Hochstraße 26, 14770, Brandenburg an der Havel, Deutschland. r.becker@klinikum-brandenburg.de. 2. Klinik Sanssouci, Helene Lange Straße 13, 14469, Potsdam, Deutschland. 3. Sporthopaedicum Berlin, Bismarckstraße 45-47, 10627, Berlin, Deutschland. 4. Zentrum für Orthopädie und Unfallchirurgie, Hochschulklinikum Brandenburg, Medizinische Hochschule Theodor Fontane, Hochstraße 26, 14770, Brandenburg an der Havel, Deutschland.
Abstract
BACKGROUND: The treatment of degenerative meniscal lesions has received increased attention since the publication of several Level 1 studies over the last few years. The following review of literature including the consensus statement given by ESSKA reports on the management of patients with degenerative meniscal lesions. MATERIAL AND METHODS: The analysis includes the literature of Level 1 to 4 studies and the statement of the consensus group of ESSKA concerning the surgical or conservative management of these patients. RESULTS: Meniscal lesions cause progression in osteoarthritis. Patients presenting a combination of degenerative meniscal lesion and osteoarthritis show inferior clinical outcome. The average clinical outcome after surgical treatment was 70 points based on the Lysholm score. Level 1 studies show no difference in clinical outcome. However, over 30% of these patients require arthroscopy at the second stage after an interval of 3 to 6 months. Patients presenting a flap tear or complaining about mechanical symptoms show poor outcome after conservative treatment. DISCUSSION: Level 1 studies have focused on very selected patients. These patients do not represent the daily practice of orthopaedic surgeons. The findings of the level 1 studies should, therefore, not be generalized. According to the consensus statement of ESSKA, the treatment of degenerative meniscal lesions should start with conservative management. In the case of persistent symptoms, surgery should be considered after 3 months. In the case of mechanical symptoms, arthroscopy might be indicated earlier. Arthroscopy in advanced osteoarthritic knees is not indicated due to inferior clinical outcome.
BACKGROUND: The treatment of degenerative meniscal lesions has received increased attention since the publication of several Level 1 studies over the last few years. The following review of literature including the consensus statement given by ESSKA reports on the management of patients with degenerative meniscal lesions. MATERIAL AND METHODS: The analysis includes the literature of Level 1 to 4 studies and the statement of the consensus group of ESSKA concerning the surgical or conservative management of these patients. RESULTS: Meniscal lesions cause progression in osteoarthritis. Patients presenting a combination of degenerative meniscal lesion and osteoarthritis show inferior clinical outcome. The average clinical outcome after surgical treatment was 70 points based on the Lysholm score. Level 1 studies show no difference in clinical outcome. However, over 30% of these patients require arthroscopy at the second stage after an interval of 3 to 6 months. Patients presenting a flap tear or complaining about mechanical symptoms show poor outcome after conservative treatment. DISCUSSION: Level 1 studies have focused on very selected patients. These patients do not represent the daily practice of orthopaedic surgeons. The findings of the level 1 studies should, therefore, not be generalized. According to the consensus statement of ESSKA, the treatment of degenerative meniscal lesions should start with conservative management. In the case of persistent symptoms, surgery should be considered after 3 months. In the case of mechanical symptoms, arthroscopy might be indicated earlier. Arthroscopy in advanced osteoarthritic knees is not indicated due to inferior clinical outcome.
Authors: Victor A van de Graaf; Vanessa A B Scholtes; Nienke Wolterbeek; Julia C A Noorduyn; Camille Neeter; Maurits W van Tulder; Daniël B F Saris; Arthur de Gast; Rudolf W Poolman Journal: BMJ Open Date: 2016-12-21 Impact factor: 2.692
Authors: Ph Beaufils; R Becker; S Kopf; M Englund; R Verdonk; M Ollivier; R Seil Journal: Knee Surg Sports Traumatol Arthrosc Date: 2017-02-16 Impact factor: 4.342