Erik Hohmann1, Richard Angelo2, Robert Arciero3, Bernard R Bach4, Brian Cole4, Mark Cote3, Jack Farr5, Julian Feller6, Brad Gelbart7, Andreas Gomoll8, Andreas Imhoff9, Robert LaPrade10, Bert R Mandelbaum11, Robert G Marx8, Juan C Monllau12, Frank Noyes13, David Parker14, Scott Rodeo15, Nicholas Sgaglione16, Kevin Shea17, Donald K Shelbourne18, Shinichi Yoshiya19, Vaida Glatt20, Kevin Tetsworth21. 1. Department of Orthopaedic Surgery and Sportsmedicine, Valiant Clinic/Houston Methodist, Dubai, United Arab Emirates. Electronic address: ehohmann@hotmail.com. 2. Woodinville, Washington, U.S.A. 3. Department of Orthopaedic Surgery, University of Connecticut, Farmington, U.S.A. 4. Midwestern Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A. 5. Cartilage Restoration Center of Indiana, Indianapolis, Indiana, U.S.A. 6. OrthoSportVictoria, Epworth Healthcare, Melbourne, Australia. 7. Linksfield Orthopaedic Sports and Rehabilitation Centre, Centre for Sports Medicine and Orthopaedics, Johannesburg, South Africa. 8. Hospital for Special Surgery, New York, New York, U.S.A. 9. Department of Orthopaedic Sports Medicine, Technical University Munich, Munich, Germany. 10. The Steadman Clinic, Vail, Colorado, U.S.A. 11. Santa Monica, California, U.S.A. 12. Barcelona, Spain. 13. Cincinnati Sportsmedicine and Orthopaedic Centre, Cincinnati, Ohio, U.S.A. 14. Sydney Orthopaedic Research Institute, Sydney, Australia. 15. Sportsmedicine and Shoulder Service, Hospital for Special Surgery, New York, New York, U.S.A. 16. Northwell Health Orthopaedics, Great Neck, New York, U.S.A. 17. Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A. 18. Shelbourne Knee Center, Community East Hospital, Indianapolis, Indiana, U.S.A. 19. Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya City, Hyogo, Japan. 20. University of Texas Health Science Center, San Antonio, Texas, U.S.A.; Orthopaedic Research Centre of Australia, Brisbane, Australia. 21. Orthopaedic Research Centre of Australia, Brisbane, Australia; Department of Orthopaedic Surgery, Royal Brisbane Hospital, Herston, Australia.
Abstract
PURPOSE: The purpose of this study was to perform an evidence-based, expert consensus survey using the Delphi panel methodology to develop recommendations for the treatment of degenerative meniscus tears. METHODS: Twenty panel members were asked to respond to 10 open-ended questions in rounds 1 and 2. The results of the first 2 rounds served to develop a Likert-style questionnaire for round 3. In round 4, the panel members outside consensus were contacted and asked to either change their score in view of the group's response or argue their case. The level of agreement for round 4 was defined as 80%. RESULTS: There was 100% agreement on the following items: insidious onset, physiological part of aging, tears often multiplanar, not all tears cause symptoms, outcomes depend on degree of osteoarthritis, obesity is a predictor of poor outcome, and younger patients (<50 years) have better outcomes. There was between 90% and 100% agreement on the following items: tears are nontraumatic, radiographs should be weightbearing, initial treatment should be conservative, platelet-rich plasma is not a good option, repairable and peripheral tears should be repaired, microfracture is not a good option for chondral defects, the majority of patients obtain significant improvement and decrease in pain with surgery but results are variable, short-term symptoms have better outcomes, and malalignment and root tears have poor outcomes. CONCLUSIONS: This consensus statement agreed that degenerative meniscus tears are a normal part of aging. Not all tears cause symptoms and, when symptomatic, they should initially be treated nonoperatively. Repairable tears should be repaired. The outcome of arthroscopic partial meniscectomy depends on the degree of osteoarthritis, the character of the meniscus lesion, the degree of loss of joint space, the amount of malalignment, and obesity. The majority of patients had significant improvement, but younger patients and patients with short-term symptoms have better outcomes. LEVEL OF EVIDENCE: Level V - expert opinion.
PURPOSE: The purpose of this study was to perform an evidence-based, expert consensus survey using the Delphi panel methodology to develop recommendations for the treatment of degenerative meniscus tears. METHODS: Twenty panel members were asked to respond to 10 open-ended questions in rounds 1 and 2. The results of the first 2 rounds served to develop a Likert-style questionnaire for round 3. In round 4, the panel members outside consensus were contacted and asked to either change their score in view of the group's response or argue their case. The level of agreement for round 4 was defined as 80%. RESULTS: There was 100% agreement on the following items: insidious onset, physiological part of aging, tears often multiplanar, not all tears cause symptoms, outcomes depend on degree of osteoarthritis, obesity is a predictor of poor outcome, and younger patients (<50 years) have better outcomes. There was between 90% and 100% agreement on the following items: tears are nontraumatic, radiographs should be weightbearing, initial treatment should be conservative, platelet-rich plasma is not a good option, repairable and peripheral tears should be repaired, microfracture is not a good option for chondral defects, the majority of patients obtain significant improvement and decrease in pain with surgery but results are variable, short-term symptoms have better outcomes, and malalignment and root tears have poor outcomes. CONCLUSIONS: This consensus statement agreed that degenerative meniscus tears are a normal part of aging. Not all tears cause symptoms and, when symptomatic, they should initially be treated nonoperatively. Repairable tears should be repaired. The outcome of arthroscopic partial meniscectomy depends on the degree of osteoarthritis, the character of the meniscus lesion, the degree of loss of joint space, the amount of malalignment, and obesity. The majority of patients had significant improvement, but younger patients and patients with short-term symptoms have better outcomes. LEVEL OF EVIDENCE: Level V - expert opinion.
Authors: Betina B Hinckel; Charles A Baumann; Leandro Ejnisman; Leonardo M Cavinatto; Alexander Martusiewicz; Miho J Tanaka; Marc Tompkins; Seth L Sherman; Jorge A Chahla; Rachel Frank; Guilherme L Yamamoto; James Bicos; Liza Arendt; Donald Fithian; Jack Farr Journal: J Am Acad Orthop Surg Glob Res Rev Date: 2020-10-01
Authors: Kenneth R Zaslav; Jack Farr; Richard Alfred; R Maxwell Alley; Michael Dyle; Andreas H Gomoll; Christian Lattermann; Brian P McKeon; Christopher C Kaeding; Thomas Giel; Elliott B Hershman Journal: Knee Surg Sports Traumatol Arthrosc Date: 2021-04-21 Impact factor: 4.342