Amanda Avila1, Kinjal Vasavada2, Dhruv S Shankar2, Massimo Petrera2, Laith M Jazrawi2, Eric J Strauss2. 1. Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA. amanda.avila@nyulangone.org. 2. Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA.
Abstract
PURPOSE OF REVIEW: Given the continued controversy among orthopedic surgeons regarding the indications and benefits of arthroscopic partial meniscectomy (APM), this review summarizes the current literature, indications, and outcomes of partial meniscectomy to treat symptomatic meniscal tears. RECENT FINDINGS: In patients with symptomatic meniscal tears, the location and tear pattern play a vital role in clinical management. Tears in the central white-white zone are less amenable to repair due to poor vascularity. Patients may be indicated for APM or non-surgical intervention depending on the tear pattern and symptoms. Non-surgical management for meniscal pathology includes non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy (PT), and intraarticular injections to reduce inflammation and relieve symptoms. There have been several landmark multicenter randomized controlled trials (RCTs) studying the outcomes of APM compared to PT or sham surgery in symptomatic degenerative meniscal tears. These most notably include the 2013 Meniscal Tear in Osteoarthritis Research (MeTeOR) Trial, the 2018 ESCAPE trial, and the sham surgery-controlled Finnish Degenerative Meniscal Lesion Study (FIDELITY), which failed to identify substantial benefits of APM over nonoperative treatment or even placebo surgery. Despite an abundance of literature exploring outcomes of APM for degenerative meniscus tears, there is little consensus among surgeons about the drivers of good outcomes following APM. It is often difficult to determine if the presenting symptoms are secondary to the meniscus pathology or the degenerative disease in patients with concomitant OA. A central tenet of managing meniscal pathology is to preserve tissue whenever possible. Most RCTs show that exercise therapy may be non-inferior to APM in degenerative tears if repair is not possible. Given this evidence, patients who fail nonoperative treatment should be counseled regarding the risks of APM before proceeding to surgical management.
PURPOSE OF REVIEW: Given the continued controversy among orthopedic surgeons regarding the indications and benefits of arthroscopic partial meniscectomy (APM), this review summarizes the current literature, indications, and outcomes of partial meniscectomy to treat symptomatic meniscal tears. RECENT FINDINGS: In patients with symptomatic meniscal tears, the location and tear pattern play a vital role in clinical management. Tears in the central white-white zone are less amenable to repair due to poor vascularity. Patients may be indicated for APM or non-surgical intervention depending on the tear pattern and symptoms. Non-surgical management for meniscal pathology includes non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy (PT), and intraarticular injections to reduce inflammation and relieve symptoms. There have been several landmark multicenter randomized controlled trials (RCTs) studying the outcomes of APM compared to PT or sham surgery in symptomatic degenerative meniscal tears. These most notably include the 2013 Meniscal Tear in Osteoarthritis Research (MeTeOR) Trial, the 2018 ESCAPE trial, and the sham surgery-controlled Finnish Degenerative Meniscal Lesion Study (FIDELITY), which failed to identify substantial benefits of APM over nonoperative treatment or even placebo surgery. Despite an abundance of literature exploring outcomes of APM for degenerative meniscus tears, there is little consensus among surgeons about the drivers of good outcomes following APM. It is often difficult to determine if the presenting symptoms are secondary to the meniscus pathology or the degenerative disease in patients with concomitant OA. A central tenet of managing meniscal pathology is to preserve tissue whenever possible. Most RCTs show that exercise therapy may be non-inferior to APM in degenerative tears if repair is not possible. Given this evidence, patients who fail nonoperative treatment should be counseled regarding the risks of APM before proceeding to surgical management.
Authors: W L Bargar; J R Moreland; K L Markolf; S C Shoemaker; H C Amstutz; T T Grant Journal: Clin Orthop Relat Res Date: 1980 Jul-Aug Impact factor: 4.176
Authors: David S Logerstedt; Lynn Snyder-Mackler; Richard C Ritter; Michael J Axe Journal: J Orthop Sports Phys Ther Date: 2010-06 Impact factor: 4.751
Authors: Geoffrey D Abrams; Rachel M Frank; Anil K Gupta; Joshua D Harris; Frank M McCormick; Brian J Cole Journal: Am J Sports Med Date: 2013-07-17 Impact factor: 6.202
Authors: J Bruce Moseley; Kimberly O'Malley; Nancy J Petersen; Terri J Menke; Baruch A Brody; David H Kuykendall; John C Hollingsworth; Carol M Ashton; Nelda P Wray Journal: N Engl J Med Date: 2002-07-11 Impact factor: 91.245
Authors: Jonas Bloch Thorlund; Martin Englund; Robin Christensen; Nis Nissen; Kenneth Pihl; Uffe Jørgensen; Jeppe Schjerning; L Stefan Lohmander Journal: BMJ Date: 2017-02-02
Authors: Ewa M Roos; Kristoffer Borbjerg Hare; Sabrina Mai Nielsen; Robin Christensen; L Stefan Lohmander Journal: BMJ Open Date: 2018-02-02 Impact factor: 2.692