Management of traumatic meniscus tears: the 2019 ESSKA meniscus consensus

Abstract

Purpose The importance of meniscus integrity in the prevention of early osteoarthritis is well known, and preservation is accepted as the primary goal. The purpose of the ESSKA (European Society for Sports Traumatology, Knee Surgery and Arthroscopy) European consensus on traumatic meniscus tears was to provide recommendations for the treatment of meniscus tears based on both scientific evidence and the clinical experience of knee experts. Methods Three groups of surgeons and scientists elaborated and ratified the so-called formal consensus process to define the recommendations for the management of traumatic meniscus tears. A traumatic meniscus tear was defined as a tear with an acute onset of symptoms caused by a sufficient trauma. The expert groups included a steering group of eight European surgeons and scientists, a rating group of another nineteen European surgeons, and a peer review group. The steering group prepared twenty-seven question and answer sets based on the scientific literature. The quality of the answers received grades of A (a high level of scientific support), B (scientific presumption), C (a low level of scientific support) or D (expert opinion). These question and answer sets were then submitted to and evaluated by the rating group. All answers were scored from 1 (= totally inappropriate) to 9 (= totally appropriate) points. Thereafter, the comments of the members of the rating group were incorporated by the steering group and the consensus was submitted to the rating group a second time. Once a general consensus was reached between the steering and rating groups, the finalized question and answer sets were submitted for final review by the peer review group composed of representatives of the ESSKA-affiliated national societies. Eighteen representatives replied. Results The review of the literature revealed a rather low scientific quality of studies examining the treatment of traumatic meniscus tears. Of the 27 questions, only one question received a grade of A (a high level of scientific support), and another received a grade of B (scientific presumption). The remaining questions received grades of C and D. The mean rating of all questions by the rating group was 8.2 (95% confidence interval 8.1-8.4). A general agreement that MRI should be performed on a systematic basis was not achieved. However, MRI was recommended when arthroscopy would be considered to identify concomitant pathologies. In this case, the indication for MRI should be determined by a musculoskeletal specialist. Based on our data, stable left in situ lateral meniscus tears appear to show a better prognosis than medial tears. When repair is required, surgery should be performed as early as possible. Evidence that biological enhancement such as needling or the application of platelet-rich plasma would improve healing was not identified. Preservation of the meniscus should be considered as the first line of treatment because of an inferior clinical and radiological long-term outcome after partial meniscectomy compared to menis...

Clinical practice and postoperative rehabilitation after knee arthroscopy vary according to surgeons’ expertise: a survey among Polish Arthroscopy Society members.

“…Magnetic resonance imaging (MRI) is considered to be the most accurate method for imaging the internal knee joint structure, with sensitivities in detecting medial meniscus lesions ranging from 83% to 94% [41,42,43]. The ESSKA meniscus consensus group recommended MRI when arthroscopy is considered to identify concomitant pathologies [17]. Magnetic resonance as a diagnostic test for meniscus damage was recommended by 97% of orthopaedists in this study.…”

“…Therefore, studies aimed at the analysis of existing meniscus repair methods are very important. Recently, the European Society for Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) consensus provided recommendations for the treatment of meniscus tears based on both scienti c evidence and the clinical experience of expert knee surgeons [16,17]. Other studies have shown that a surgeon's level of expertise signi cantly affects clinical outcomes in patients undergoing knee arthroscopy [18,19].…”

Clinical practice and post-operative rehabilitation after knee arthroscopy varies according to surgeon's expertise: a survey among Polish Arthroscopy Society members.

“…Magnetic resonance imaging (MRI) is considered to be the most accurate method of imaging of the internal knee joint structure, with sensitivity in detecting medial meniscus lesions ranging from 83% to 94% [41,42,43]. The ESSKA European meniscus consensus group recommended using MRI when arthroscopy would be considered to identify concomitant pathologies [17]. Magnetic resonance as a diagnostic test for meniscus damage was recommended by 97% orthopedists in this study.…”

“…Therefore, studies aimed at analysis of the existing meniscus repair methods are very actual. Recently, the European Society for Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) European consensus provided recommendations for the treatment of meniscus tears based on both, scienti c evidence and the clinical experience of knee expert surgeons [16,17]. Other studies have shown that the surgeon's level of expertise signi cantly affects the clinical outcomes in patients undergoing knee arthroscopy [18,19].…”

From meniscal resection to meniscal repair: a journey of the last decade

“…In contrast, a degenerative meniscal lesion occurs due to repetitive minor injuries and lacks a sufficiently serious single trauma. The second European Consensus has studied the epidemiology, diagnosis and treatment of traumatic meniscal tears [ 14 ]. It follows the first consensus on the management of degenerative meniscal lesions, which was published in 2017 [ 3 ].…”