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An International Delphi Consensus on Meniscus Radial Tears: From Diagnosis to Management and Rehabilitation
Lika Dzidzishvili1,2, James L Pace3, David C Flanigan4
1Department of Orthopaedic Surgery Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Barcelona, Spain.
Purpose:
To establish consensus statements on risk factors, diagnosis, nonoperative management, surgical indications and techniques, rehabilitation strategies, and clinical and functional outcomes of meniscus radial tears (MRT).
Methods:
A working group of fellowship-trained sports medicine surgeons developed original statements based on a review of the current literature on MRT. A panel of 45 international orthopaedic surgeons was surveyed. Agreement with each statement was assessed using a 5-point Likert scale, and statements were retained, revised, or excluded according to predefined thresholds (≥80% agreement and <20% disagreement). Expert-suggested revisions and additional statements generated during the first 2 rounds were further reviewed and voted on in the final round 3.
Results:
The expert panel achieved consensus on repair for isolated acute traumatic MRTs and those associated with acute cruciate ligament injuries, whereas repair in chronic degenerative tears should be based on meniscal tissue quality and degree of osteoarthritis. Although partial meniscectomy may provide short-term relief, its long-term detrimental effects should not be underestimated. Increased age alone was not considered a risk factor for MRT repair. Successful healing requires addressing peripheral extension and gapping, with anatomic restoration prioritized over surgical technique or suture choice. Given limited evidence on early weightbearing and unrestricted motion, a conservative postoperative protocol is advised. No repair technique has proven superior with choice guided by surgeon preference.
Conclusions:
Expert consensus supports repair of acute traumatic and acute cruciate ligament-associated MRTs, whereas indications for chronic degenerative tears depend on tissue quality and joint status. Increased age alone was not considered a contraindication to MRT repair. Anatomic restoration is essential for a successful outcome, irrespective of surgical technique. An initial nonweight-bearing rehabilitation protocol is recommended.
Level Of Evidence:
Level V, expert opinion, modified Delphi consensus.
