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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 …
This paper is dedicated to the memory of Andy Sprowson who died tragically on 13 March 2015. He was an academic orthopaedic surgeon who was dedicated to improving evidence based care in his field. He was an exceptionally enthusiastic, bubbly character, who loved to work hard and make new and exciting things happen. He will be sadly missed by both his academic and clinical colleagues.
Contributors: All three authors jointly wrote the article and are responsible for the overall content as guarantors.
Funding: RB is funded by an Australian National Health and Medical Research Council (NHMRC) senior principal research fellowship.
Competing interests: None declared.
Provenance and peer review: Commissioned; externally peer reviewed.
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