The Role of Arthroscopic Partial Meniscectomy in the Management of Degenerative Meniscus Tears: A Review of the Recent Literature

Azam, Mohsin; Shenoy, R. N.

doi:10.2174/1874325001610010797

Cited by 11 publications

(9 citation statements)

References 45 publications

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“…Yim et al [45] performed a study comparing partial meniscectomies with nonoperative treatment methods and found no differences between the two groups in visual analog scale scores, Lysholm scores, Tegner activity scales, or subjective satisfaction. Other studies have shown similar results [5,39]. Taken together, the reported clinical lack of efficacy and the adverse biomechanical effects found in this study support avoiding partial meniscectomy in younger patients with minimal meniscal degradation to best maintain normal contact mechanics of the knee.…”

Section: Discussionsupporting

confidence: 77%

Tibiofemoral Contact Mechanics With Horizontal Cleavage Tears and Treatment of the Lateral Meniscus in the Human Knee: An In Vitro Cadaver Study

Koh

Zimmerman

Patel

et al. 2018

Clin Orthop Relat Res

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In vitro resection of one or both leaves of a horizontal cleavage tear of the lateral meniscus causes increases in peak pressure, consistent with other types of partial meniscectomies associated in a clinical setting with excessive loading and damage to knee cartilage. Clinical outcomes in patients undergoing partial leaf meniscectomy could confirm this theory. Avoidance of resection may be relatively beneficial for long-term function. The findings of this in vitro study lend biomechanical support for nonoperative management.

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Section: Discussionsupporting

confidence: 77%

Tibiofemoral Contact Mechanics With Horizontal Cleavage Tears and Treatment of the Lateral Meniscus in the Human Knee: An In Vitro Cadaver Study

Koh

Zimmerman

Patel

et al. 2018

Clin Orthop Relat Res

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“…5,52,54 Nevertheless, the role of arthroscopic surgery in the treatment of degenerative meniscal tears remains controversial. 2,30,33 A recent review concluded that these patients could benefit from arthroscopic meniscectomy but that nonsurgical treatment should be considered first. 29 Mechanical symptoms were previously considered an indication for surgery; however, recent data have contradicted this tenet.…”

mentioning

confidence: 99%

Knee Arthroscopic Surgery in Middle-Aged Patients With Meniscal Symptoms: A 5-Year Follow-up of a Prospective, Randomized Study

Sonesson

Kvist

Yakob

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Arthroscopic meniscal surgery is a common orthopaedic procedure in middle-aged patients, but the efficacy of this procedure has been questioned. In this study, we followed up the only randomized controlled trial that has shown a 1-year benefit from knee arthroscopic surgery with an exercise program compared with an exercise program alone. Purpose: To (1) evaluate whether knee arthroscopic surgery combined with an exercise program provided an additional 5-year benefit compared with an exercise program alone in middle-aged patients with meniscal symptoms, (2) determine whether baseline mechanical symptoms affected the outcome, and (3) compare radiographic changes between treatment groups. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Of 179 eligible patients aged 45 to 64 years, 150 were randomized to either a 3-month exercise program (nonsurgery group) or to the same exercise program plus knee arthroscopic surgery (surgery group) within 4 weeks. Radiographs were assessed, according to the Kellgren-Lawrence grade, at baseline and at the 5-year follow-up. The primary outcome was the change in Knee injury and Osteoarthritis Outcome Score (KOOS)–Pain (KOOSPAIN) subscore from baseline to the 5-year follow-up. We performed an as-treated analysis. Results: A total of 102 patients completed the 5-year questionnaire. At the 5-year follow-up, both groups had significant improvement in KOOSPAIN subscores, although there was no significant change from the 3-year scores. There was no between-group difference in the change in the KOOSPAIN subscore from baseline to 5 years (3.2 points [95% CI, –6.1 to 12.4]; adjusted P = .403). In the surgery group, improvement was greater in patients without mechanical symptoms than in those with mechanical symptoms (mean difference, 18.4 points [95% CI, 8.7 to 28.1]; P < .001). Radiographic deterioration occurred in 60% of patients in the surgery group and 37% of those in the nonsurgery group ( P = .060). Conclusion: Knee arthroscopic surgery combined with an exercise program provided no additional long-term benefit after 5 years compared with the exercise program alone in middle-aged patients with meniscal symptoms. Surgical outcomes were better in patients without mechanical symptoms than in patients with mechanical symptoms during the preoperative period. Radiographic changes did not differ between treatment groups. Registration: NCT01288768 ( ClinicalTrials.gov identifier).

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“…8,20,38 These high rates may reflect a need for more careful patient selection when considering meniscectomy. 2 After partial or total meniscectomy, the remaining treatment options are very limited for patients with persistent or recurrent pain. Current standards of care include nonsurgical interventions, such as intra-articular injections, unloading braces, and physical therapy.…”

mentioning

confidence: 99%

“… 8 , 20 , 38 These high rates may reflect a need for more careful patient selection when considering meniscectomy. 2 …”

mentioning

confidence: 99%

Preliminary Results From a US Clinical Trial of a Novel Synthetic Polymer Meniscal Implant

McKeon

Zaslav

Alfred

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: At least 760,000 outpatient meniscectomies are performed in the United States each year, making this the most common musculoskeletal procedure. However, meniscal resection can alter the joint biomechanics and overload the articular cartilage, which may contribute to degenerative changes and the need for knee replacement. Avoiding or delaying knee replacement is particularly important in younger or more active patients. Synthetic meniscal implants have been developed in an attempt to restore the natural joint biomechanics, alleviate pain and disability, and potentially minimize degenerative changes in patients who require meniscectomy. Purpose To evaluate the preliminary results from 2 ongoing trials that are evaluating the safety and effectiveness of a synthetic polymer meniscal implant (NUsurface; Active Implants, LLC). Study Design: Cohort study; Level of evidence, 2. Methods: This was a preliminary analysis of the first 100 patients enrolled across 2 studies for 12 months: a single-arm, intervention-only study and a randomized controlled trial comparing the investigational meniscal implant with nonsurgical therapy. There were 65 patients in the implant group (30 randomized) and 35 in the control group. Outcomes included Knee injury and Osteoarthritis Outcome Score (KOOS) and adverse events (AEs) collected at baseline and follow-up visits of 6 weeks, 6 months, and 12 months. Results: No statistically significant differences were found in baseline characteristics between the implant and control groups. At 12 months, follow-up KOOS data were available for 87% of the 100 included patients. Significantly greater improvements from baseline were observed in the implant group compared with controls in all KOOS subcomponents, except for symptoms (119%-177% greater improvement at 12 months). AEs were reported at similar rates between the 2 groups, with 12 AEs among 11 patients in the implant group (16.9%) versus 5 AEs among 5 patients (14.3%) in the control group ( P = .99). Conclusion: These preliminary results suggest significant improvements in pain and function scores with the implant over nonsurgical therapy and a similar adverse event rate.

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The Role of Arthroscopic Partial Meniscectomy in the Management of Degenerative Meniscus Tears: A Review of the Recent Literature

Cited by 11 publications

References 45 publications

Tibiofemoral Contact Mechanics With Horizontal Cleavage Tears and Treatment of the Lateral Meniscus in the Human Knee: An In Vitro Cadaver Study

Tibiofemoral Contact Mechanics With Horizontal Cleavage Tears and Treatment of the Lateral Meniscus in the Human Knee: An In Vitro Cadaver Study

Knee Arthroscopic Surgery in Middle-Aged Patients With Meniscal Symptoms: A 5-Year Follow-up of a Prospective, Randomized Study

Preliminary Results From a US Clinical Trial of a Novel Synthetic Polymer Meniscal Implant

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