Meniscal pathology - the evidence for treatment

Area of Science:

• Orthopaedic Surgery
• Sports Medicine
• Radiology

Background:

• Meniscal tears are common in adults, often found incidentally on MRI.
• Arthroscopic surgery for meniscal tears is prevalent but its efficacy compared to conservative treatments is debated.
• Current surgical approaches include partial menisectomy and meniscal repair, with age being a primary determinant of the chosen method.

Purpose of the Study:

• To review the evidence for arthroscopic treatment of meniscal tears.
• To compare the efficacy of meniscal repair versus partial menisectomy.
• To provide recommendations for the first-line treatment of degenerative meniscal tears.

Main Methods:

• Review of existing literature, including randomized controlled trials (RCTs), cohort studies, and case series.
• Analysis of factors influencing surgical approach, particularly patient age.
• Comparison of outcomes between surgical interventions and conservative therapies.

Main Results:

• Evidence supporting arthroscopic treatment of meniscal tears over conservative therapies is limited and controversial.
• Arthroscopic partial menisectomy (APM) in older adults does not address underlying osteoarthritis.
• Conservative therapy, including weight loss, is recommended for degenerative meniscal tears in older adults, except when mechanical symptoms dominate.
• Meniscal repair may offer functional and long-term osteoarthritis benefits in younger adults, though evidence requires further RCT corroboration.

Conclusions:

• Conservative management is the recommended first-line treatment for degenerative meniscal tears in most older adults.
• Meniscal repair shows promise for younger adults to improve function and reduce long-term osteoarthritis risk.
• Further RCTs are needed to confirm the superiority of meniscal repair over APM and to identify subgroups benefiting from surgery.