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Management of degenerative meniscal tears and the role of surgery
  1. Rachelle Buchbinder1,2,
  2. Ian A Harris3,
  3. Andrew Sprowson4
  1. 1Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Australia
  2. 2Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, Melbourne, Vic, Australia
  3. 3Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, NSW, Australia
  4. 4Warwick Clinical Trials Unit, Warwick University, Coventry, UK
  1. Correspondence to R Buchbinder rachelle, buchbinder{at}monash.edu

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The use of knee arthroscopy to treat degenerative meniscal tears is well established worldwide. However, with the advent of high quality randomised controlled trials questioning its value, observations that these lesions are usually asymptomatic, and recognition that arthroscopy is a “difficult habit to break,”1 it is timely to review the best evidence based management of these tears and reconsider the role of surgery.

Classification of meniscal tears

The menisci are two largely aneural crescent shaped discs of fibrocartilage, which sit within the lateral and medial compartments of the knee joint. They evenly transfer load across the joint, absorb shock during dynamic movement, and lubricate and help stabilise the joint. Injury, degeneration, or surgical removal of all or part of the meniscus is associated with an increased risk of developing knee osteoarthritis.2 The risk of osteoarthritis and its progression increase in line with reductions in tibial cartilage coverage.

Meniscal tears are categorised as traumatic or non-traumatic (degenerative) on the basis of their presentation. Traumatic tears tend to occur in younger active people (<40 years) and are caused by a serious traumatic injury, often while playing sport. Degenerative tears are typically seen in middle aged or older people and often accompany knee osteoarthritis; the prevalence of meniscal damage increases as joint space narrowing becomes more severe.3 ,4 The medial meniscus is the most commonly torn, and multiple tears are present in more than a third of patients.

Who is at risk?

Population based magnetic resonance imaging (MRI) studies report a 35% prevalence of degenerative meniscal tears in people over 50 years,3 and a 24% prevalence in those with no radiographic evidence of osteoarthritis.5 Most meniscal tears are asymptomatic and prevalence is similar in those with and without knee pain (20% v 25%).5 Although some studies have found that body mass index (BMI) does …

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