Our Summary

This research paper is about the best approaches for treating injuries to the meniscus, a piece of cartilage in the knee. The European Society for Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) created a consensus, or agreement, based on the available scientific evidence and expert opinions. Three groups of surgeons and scientists contributed to this consensus.

They found that much of the existing research on treating meniscus injuries isn’t very high-quality. They agreed that the first line of treatment should be trying to preserve the meniscus, as outcomes tend to be worse when part of the meniscus is removed. However, there wasn’t agreement on whether an MRI should always be used when diagnosing these injuries, though it was recommended when considering surgery to identify any additional issues.

The paper also suggests that many meniscus injuries previously thought to be unrepairable should actually be fixed, including older injuries, injuries in overweight patients, and more severe tears. When surgery is needed, it should be done as soon as possible. The paper does not support the use of biological enhancements, like needling or platelet-rich plasma, to improve healing.

FAQs

  1. What is the first line of treatment recommended by ESSKA for meniscus injuries?
  2. Is there a consensus on using MRIs for diagnosing meniscus injuries?
  3. Does the ESSKA’s research paper support the use of biological enhancements like needling or platelet-rich plasma for improving healing of meniscus injuries?

Doctor’s Tip

A doctor might tell a patient undergoing a meniscectomy that preserving as much of the meniscus as possible is important for better outcomes. They may also recommend getting an MRI before surgery to identify any additional issues. Additionally, the sooner the surgery is done, the better the outcome is likely to be. The use of biological enhancements like needling or platelet-rich plasma is not supported for improving healing.

Suitable For

Patients who are typically recommended for meniscectomy include those with large, complex tears that are not amenable to repair, as well as patients who have recurrent symptoms despite conservative treatments such as physical therapy or corticosteroid injections. Additionally, patients who have mechanical symptoms such as locking or catching of the knee may also be candidates for meniscectomy. Older patients or those with degenerative changes in the knee may also benefit from meniscectomy to alleviate symptoms and improve function.

Timeline

Before meniscectomy:

  1. Patient experiences knee pain, swelling, and limited range of motion.
  2. Patient may undergo physical therapy or other conservative treatments to try to preserve the meniscus.
  3. An MRI may be used to diagnose the extent of the meniscus injury.
  4. If surgery is deemed necessary, the patient will undergo a meniscectomy procedure.

After meniscectomy:

  1. Patient will likely experience pain and swelling in the knee post-surgery.
  2. Physical therapy will be recommended to regain strength and range of motion in the knee.
  3. Full recovery from a meniscectomy can take several weeks to months, depending on the extent of the injury and the individual’s healing process.
  4. There is a risk of developing osteoarthritis in the knee in the long term, especially if a large portion of the meniscus is removed.

What to Ask Your Doctor

Some questions a patient should ask their doctor about meniscectomy include:

  1. What are the risks and benefits of meniscectomy compared to other treatment options?
  2. How long is the recovery period after meniscectomy and what can I expect during this time?
  3. Are there any alternative treatments or therapies that I should consider before opting for surgery?
  4. What is the success rate of meniscectomy for my specific type of meniscus injury?
  5. Will I need physical therapy after the surgery and for how long?
  6. What are the potential long-term effects of having part of my meniscus removed?
  7. Are there any restrictions or lifestyle changes I will need to make after the surgery?
  8. How soon can I return to normal activities, such as sports or exercise, after the surgery?
  9. What is the likelihood of needing additional surgeries in the future after having a meniscectomy?
  10. Are there any specific steps I should take to optimize my recovery and improve the outcome of the surgery?

Reference

Authors: Kopf S, Beaufils P, Hirschmann MT, Rotigliano N, Ollivier M, Pereira H, Verdonk R, Darabos N, Ntagiopoulos P, Dejour D, Seil R, Becker R. Journal: Knee Surg Sports Traumatol Arthrosc. 2020 Apr;28(4):1177-1194. doi: 10.1007/s00167-020-05847-3. Epub 2020 Feb 13. PMID: 32052121