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Risk factors, diagnosis and non-surgical treatment for meniscal tears: evidence and recommendations: a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF)
  1. Jonas Bloch Thorlund1,
  2. Carsten Bogh Juhl1,2,
  3. Lina Holm Ingelsrud1,3,
  4. Søren Thorgaard Skou1,4
  1. 1Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
  2. 2Department of Rehabilitation, Copenhagen University Hospital, Herlev and Gentofte, Denmark
  3. 3Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
  4. 4Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
  1. Correspondence to Jonas Bloch Thorlund, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense M, Denmark; jthorlund{at}health.sdu.dk

Abstract

This statement aimed at summarising and appraising the available evidence for risk factors, diagnostic tools and non-surgical treatments for patients with meniscal tears. We systematically searched electronic databases using a pragmatic search strategy approach. Included studies were synthesised quantitatively or qualitatively, as appropriate. Strength of evidence was determined according to the Grading of Recommendations Assessment Development and Evaluation framework. Low-quality evidence suggested that overweight (degenerative tears, k=3), male sex (k=4), contact and pivoting sports (k=2), and frequent occupational kneeling/squatting (k=3) were risk factors for meniscal tears. There was low to moderate quality evidence for low to high positive and negative predictive values, depending on the underlying prevalence of meniscal tears for four common diagnostic tests (k=15, n=2474). Seven trials investigated exercise versus surgery (k=2) or the effect of surgery in addition to exercise (k=5) for degenerative meniscal tears. There was moderate level of evidence for exercise improving self-reported pain (Effect Size (ES)−0.51, 95% CI −1.16 to 0.13) and function (ES −0.06, 95% CI −0.23 to 0.11) to the same extent as surgery, and improving muscle strength to a greater extent than surgery (ES −0.45, 95% CI −0.62 to −0.29). High-quality evidence showed no clinically relevant effect of surgery in addition to exercise on pain (ES 0.18, 95% 0.05 to 0.32) and function (ES, 0.13 95% CI −0.03 to 0.28) for patients with degenerative meniscal tears. No randomised trials comparing non-surgical treatments with surgery in patients younger than 40 years of age or patients with traumatic meniscal tears were identified. Diagnosis of meniscal tears is challenging as all clinical diagnostic tests have high risk of misclassification. Exercise therapy should be recommended as the treatment of choice for middle-aged and older patients with degenerative meniscal lesions. Evidence on the best treatment for young patients and patients with traumatic meniscal tears is lacking.

  • meniscus
  • physiotherapy
  • exercise
  • risk factor
  • diagnosis

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Footnotes

  • Contributors All authors participated in the conception and design of the statement. All authors participated in various tasks regarding data collection (ie, literature searches, study screening, data extraction, data analysis and risk of bias assessment). JBT and STS made the first draft of the manuscript. All authors provided critical input on the manuscript and approved the final version of the paper.

  • Funding The study was commissioned and funded by the Danish Society of Sports Physical Therapy (DSSF). DSSF had no influence in designing, performing or writing the study and the decision on publishing the results. STS is supported by the Danish Council for Independent Research (DFF – 6110-00045) and the Lundbeck Foundation.

  • Competing interests STS is one of the founders of Good Life with osteoArthritis in Denmark (GLA:D). GLA:D is a non-profit initiative hosted at University of Southern Denmark. The remaining authors have no conflict of interests to declare.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data available upon reasonable request.

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