Dutch Guideline on Knee Arthroscopy Part 1, the meniscus: a multidisciplinary review by the Dutch Orthopaedic Association

Abstract

Background and purpose — A guideline committee of medical specialists and a physiotherapist was formed on the initiative of the Dutch Orthopedic Association (NOV) to update the guideline Arthroscopy of the Knee: Indications and Treatment 2010. This next guideline was developed between June 2017 and December 2019. In this Part 1 we focus on the meniscus, in Part 2 on all other aspects of knee arthroscopy. Methods — The guideline was developed in accordance with the criteria of the AGREE instrument (AGREE II: Appraisal of Guidelines for Research and Evaluation II) with support of a professional methodologist from the Dutch Knowledge Institute of Medical Specialists. The scientific literature was searched and systematically analyzed. Conclusions and recommendations were formulated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. Recommendations were developed considering the balance of benefits and harms, the type and quality of evidence, the values and preferences of the people involved, and the costs.

Arthroscopic partial meniscectomy versus physical therapy for traumatic meniscal tears in a young study population: a randomised controlled trial

“…A grade 3 meniscal tear has signal changes on MRI that reach the articular surface of the meniscus and therefore is considered to be a full tear. 15 Exclusion criteria were: a locked knee (ie, when the patient was unable to fully extend or flex the injured knee, confirmed by clinical examination), a meniscal tear that was suitable for suture repair based on MRI findings, 16 a concurrent rupture of the anterior or posterior cruciate ligament, radiographic signs of osteoarthritis in the index knee (Kellgren Lawrence 17 grade 2 or higher), disabling comorbidity or insufficient command of the Dutch or English language. Patients could have minor cartilage damage, which was not visible on radiographs.…”

Effect of Physical Therapy vs Arthroscopic Partial Meniscectomy in People With Degenerative Meniscal Tears

“…According to the guidelines of the Dutch Orthopedic Association, we referred patients for physical therapy only in case of delayed recovery. 10 …”

“… 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 These findings have been embedded in the most recently updated guidelines. 9 , 10 , 11 …”

An individualized decision between physical therapy or surgery for patients with degenerative meniscal tears cannot be based on continuous treatment selection markers: a marker-by-treatment analysis of the ESCAPE study

“…A detailed explanation of a predictiveness curve is provided in Supplement 4. The performance of the potential treatment selection markers was analysed under the assumption that physical therapy is the standard treatment as suggested by the current guidelines [ 21 , 24 ].…”