Editorial Commentary: Meniscal Tears or Meniscal Aging-That Is the Question

Meniscal tears constitute one of the most common pathologies in sports medicine. Although frequently grouped by shape, location, and size for didactic purposes, considering them according to their cause is probably the single most important factor to predict their behavior and prognosis. For instance, an acute traumatic tear and a degenerative tear of the meniscus are located on opposite ends of the spectrum of the meniscal pathology (which is comparable to focal chondral defects and osteoarthritis). For this reason, surgically addressing a non-obstructive degenerative meniscus does not always address the cause of the problem (inherent catabolic state) or the character of the symptoms (due to concomitant osteoarthritis or overload), and therefore, outcomes have been reported to be unpredictable. Of note, several recent randomized clinical trials allowed for a single-way crossover, which could act as a major confounder related to patient recruitment and expectation bias. Considering these thoughts along with the associated media coverage, there is a global trend to treat degenerative tears with a more conservative approach. Despite this, the most appropriate treatment for patients with symptomatic degenerative tears for which a trial of conservative measures failed is yet to be determined.