Purpose
The purpose of this study was to perform an evidence-based, expert consensus survey
using the Delphi panel methodology to develop recommendations for the treatment of
degenerative meniscus tears.
Methods
Twenty panel members were asked to respond to 10 open-ended questions in rounds 1
and 2. The results of the first 2 rounds served to develop a Likert-style questionnaire
for round 3. In round 4, the panel members outside consensus were contacted and asked
to either change their score in view of the group's response or argue their case.
The level of agreement for round 4 was defined as 80%.
Results
There was 100% agreement on the following items: insidious onset, physiological part
of aging, tears often multiplanar, not all tears cause symptoms, outcomes depend on
degree of osteoarthritis, obesity is a predictor of poor outcome, and younger patients
(<50 years) have better outcomes. There was between 90% and 100% agreement on the
following items: tears are nontraumatic, radiographs should be weightbearing, initial
treatment should be conservative, platelet-rich plasma is not a good option, repairable
and peripheral tears should be repaired, microfracture is not a good option for chondral
defects, the majority of patients obtain significant improvement and decrease in pain
with surgery but results are variable, short-term symptoms have better outcomes, and
malalignment and root tears have poor outcomes.
Conclusions
This consensus statement agreed that degenerative meniscus tears are a normal part
of aging. Not all tears cause symptoms and, when symptomatic, they should initially
be treated nonoperatively. Repairable tears should be repaired. The outcome of arthroscopic
partial meniscectomy depends on the degree of osteoarthritis, the character of the
meniscus lesion, the degree of loss of joint space, the amount of malalignment, and
obesity. The majority of patients had significant improvement, but younger patients
and patients with short-term symptoms have better outcomes.
Level of Evidence
Level V – expert opinion.
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References
- Does arthroscopic knee surgery work?.Arthroscopy. 2014; 30: 544-545
- Surgical treatment for meniscal injuries of the knee in adults.Cochrane Database Syst Rev. 2000; 2: CD001353
- Mechanical symptoms and arthroscopic partial meniscectomy in patients with degenerative meniscus tears.Ann Intern Med. 2016; 164: 449-455
- Mechanical symptoms as an indication for knee arthroscopy in patients with degenerative meniscus tear: a prospective cohort study.Osteoarthritis Cartilage. 2016; 24: 1367-1375
- Surgery versus physical therapy for a meniscal tear and osteoarthritis.N Engl J Med. 2013; 368: 1675-1684
- Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms.BMJ. 2015; 350: h2747
- Arthroscopic surgery for degenerative tears of the meniscus: a systematic review and meta-analysis.CMAJ. 2014; 186: 1057-1064
- Is arthroscopic surgery beneficial in treating non-traumatic degenerative medial meniscus tears? A five year follow-up.Knee Surg Sports Traumatol Arthrosc. 2013; 21: 358-364
- A comparative study of meniscectomy and nonoperative treatment for degenerative horizontal tears of the meniscus.Am J Sports Med. 2013; 41: 1565-1570
- Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle-aged patients: randomised controlled trial with two year follow-up.BMJ. 2016; 354: i3740
- The knee meniscus: management of tears and degenerative lesions.EFORT Open Rev. 2017; 2: 195-203
- Surgical management of degenerative meniscus lesions: the 2016 ESSKA meniscus consensus.Knee Surg Sports Traumatol Arthrosc. 2017; 25: 335-346
- Knee arthroscopy versus conservative management in patients with degenerative knee disease: a systematic review.BMJ Open. 2017; 7: e016114
- Arthroscopic surgery for knee pain: a highly questionable practice without supporting evidence of even moderate quality.Br J Sports Med. 2016; 50: 1426-1427
- Arthroscopic surgery for degenerative knee.BMJ. 2015; 350: h2983
- Is arthroscopy of the knee completely useless? Meta-analysis—a reviewer’s nightmare.J Bone Joint Surg Br. 2015; 97: 1591-1592
- An open letter to the editor of the BMJ.Arthroscopy. 2018; 34: 8-11
- The evidence base for orthopaedics and sports medicine: scandalously poor in parts.Br J Sports Med. 2016; 50: 564-565
- Controversial role of arthroscopic meniscectomy of the knee: a review.WJO. 2016; 7: 287-292
- Arthroscopic partial meniscectomy or physical therapy for degenerative meniscus lesions. How robust is the current evidence? A critical systematic review and qualitative synthesis.Arthroscopy. 2018; 34: 2699-2708
- Can we trust knee meniscus studies? One-way confounds intent-to-treat statistical methods.Arthroscopy. 2016; 32: 2187-2190
- Could the New England Journal of Medicine be biased against arthroscopic knee surgery?.Arthroscopy. 2014; 30: 536-537
- Could the New England Journal of Medicine be biased against arthroscopic knee surgery?.Part 2 Arthroscopy. 2014; 30: 654-655
- Treatment of degenerative meniscal lesions: from eminence to evidence-based medicine.Orthopade. 2017; 46: 808-821
- Expert opinion is necessary: Delphi panel methodology facilitates a scientific approach to consensus.Arthroscopy. 2018; 34: 349-351
- The Delphi technique: making sense of consensus.Practical Assess Res Eval. 2007; 12: 1-8
- An experimental application of the Delphi method to the use of experts.Manage Sci. 1963; 9: 458-467
- The Delphi method: An experimental study of group opinion. The RM-5888-PR.Rand Corp, Santa Monica, California1969
- Research pearls: expert consensus-based evidence using the Delphi method.Arthroscopy. 2018; 34: 3278-3282
- The Delphi method as a research tool: an example, design considerations and applications.Information Manage. 2004; 42: 15-29
- How to use the nominal group and Delphi techniques.Int J Clin Pharm. 2016; 38: 655-662
- Applying the Delphi technique in a study of GPs’ information requirements.Health Social Care Comm. 1999; 7: 198-205
- Research guidelines for the Delphi survey.J Adv Nurs. 2000; 32: 1008-1015
- The Delphi technique: an adaptive research tool.Br J Occup Ther. 1998; 61: 153-156
- Arthroscopic meniscectomy.in: Mcginty J.B. Jackson R.W. Poehling G.G. Operative arthroscopy. 2nd ed. Lippincott-Raven, Philadelphia1996: 263-297
- National consensus on the definition, investigation and classification of meniscal lesions of the knee.Knee. 2018; 25: 834-840
- No effects of early viscosupplementation after arthroscopic partial meniscectomy: a randomized controlled trial.Am J Sports Med. 2016; 44: 3119-3125
- Intra-articular injection of hyaluronic acid following arthroscopic partial meniscectomy of the knee.Orthopedics. 2010; 33: 724
- Percutaneous injection of platelet rich plasma for treatment of intrasubstance meniscal lesions.Muscles Ligaments Tendons J. 2015; 5: 162-166
- The regenerative effects of platelet-rich plasma on meniscal cells in vitro and its in vivo application with biodegradable gelatin hydrogel.Tissue Eng. 2007; 13: 1103-1105
- Degenerative meniscus: pathogenesis, diagnosis and treatment options.World J Orthop. 2014; 5: 597-602
- Surgical decision making for arthroscopic partial meniscectomy in patients over 40 years.Arthroscopy. 2012; 28: 492-501
- Arthroscopic partial meniscectomy or conservative treatment for nonobstructive meniscal tears: a systematic review and meta-analysis of randomized controlled trials.Arthroscopy. 2016; 32: 1855-1865
- Meniscal repair outcomes at greater than 5 years: a systematic review and meta-analysis.J Bone Joint Surg Am. 2012; 94: 2222-2227
- Meniscal repair versus partial meniscectomy: a systematic review comparing reoperation rates and clinical outcomes.Arthroscopy. 2011; 27: 1275-1288
- Long-term outcome after arthroscopic meniscal repair versus arthroscopic partial meniscectomy for traumatic meniscal tears.Am J Sports Med. 2010; 38: 1542-1548
- Is microfarcture of chondral defects in the knee associated with different results in patients aged 40 years and younger?.Arthroscopy. 2006; 22: 1180-1186
- Medial meniscus tear morphology and chondral degeneration of the knee: is there a relationship?.Arthroscopy. 2012; 28: 1124-1134
- Is there an association between articular cartilage changes and degenerative meniscus tears?.Arthroscopy. 2005; 21: 1366-1369
- Predictors of outcome after arthroscopic partial meniscectomy for acute trauma-related symptomatic medial meniscus tears in patients more than 60 years of age.Arthroscopy. 2016; 32: 1125-1132
- Arthroscopic meniscectomy for degenerative meniscus tears reduces knee pain but is not cost-effective in a routine health care setting: a multi-centre longitudinal observational study using data from the osteoarthritis initiative.Osteoarthritis Cartilage. 2018; 26: 184-194
- The cost-effectiveness of arthroscopic partial meniscectomy: comparing apples and oranges.Osteoarthritis Cartilage. 2018; 26: 152-153
- Defining the value of future research to identify the preferred treatment of meniscal tear in the presence of osteoarthritis.PLoS One. 2015; 10e0130256
- Guarding quality of evidence and strength of recommendations.BMJ. 2004; 328: 1490
- Evidence for health decision making – beyond randomized, controlled trials.N Engl J Med. 2017; 377: 465-475
- The Delphi method. An approach for facilitating evidence-based practice in athletic training.Athl Train Edu J. 2008; 3: 135-142
- The Delphi techniques: myth and realities.J Adv Nursing. 2003; 41: 376-382
- Consulting the oracle: ten lessons learned from using the Delphi technique in nursing research.J Adv Nurs. 2006; 53: 205-212
Article info
Publication history
Published online: December 31, 2019
Accepted:
August 6,
2019
Received:
February 26,
2019
Footnotes
See commentary on page 513
The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2019 by the Arthroscopy Association of North America. Published by Elsevier. All rights reserved.
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- ErratumArthroscopyVol. 36Issue 10
- Editorial Commentary: Degenerative Meniscal Tear: Sojourn to the OracleArthroscopyVol. 36Issue 2
- PreviewDegenerative meniscal tears are prevalent and give rise to more than 400,000 arthroscopic partial meniscectomies annually in the United States. These lesions often occur in the setting of knee osteoarthritis and are generally regarded as a component of the tissue damage (to cartilage, meniscus, bone, synovium among others) that comprises osteoarthritis. A wide array of clinicians, ranging from orthopaedic surgeons to general practitioners, regularly encounter symptomatic degenerative meniscal tears, especially among patients with knee osteoarthritis.
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