Abstract
PurposeThe 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.MethodsThree 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.ResultsThe 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 meniscus repair.DiscussionThe consensus was generated to present the best possible recommendations for the treatment of traumatic meniscus tears and provides some groundwork for a clinical decision-making process regarding the treatment of meniscus tears. Preservation of the meniscus should be the first line of treatment when possible, because the clinical and radiological long-term outcomes are worse after partial meniscectomy than after meniscus preservation. The consensus clearly states that numerous meniscus tears that were considered irreparable should be repaired, e.g., older tears, tears in obese patients, long tears, etc.Level of evidenceII
Highlights
The nomenclature of traumatic and degenerative chronic meniscus injuries should be distinguished based on their etiology
After a general agreement was achieved in the steering group, the questions were submitted to the rating group, which consisted of 19 European orthopedic surgeons, physiotherapists and scientists specialized in knee pathologies
Preservation of the meniscus is the first-line option because the clinical and radiological long-term outcomes are worse after partial meniscectomy than meniscus repair [8, 9, 69, 146–149]
Summary
The nomenclature of traumatic and degenerative chronic meniscus injuries should be distinguished based on their etiology. Debate exists regarding whether tears of the meniscus ramp should be included under the purview of traumatic meniscus tears, they are generally accepted to occur at a ligamentous connection between the posterior horn of the medial meniscus and the tibial plateau. These meniscal ramp tears often do not affect the actual meniscus tissue and were not counted as true meniscus tears in this consensus. Horizontal lesions are not considered traumatic meniscus tears because of their rather degenerative nature, even if they occur in younger patients [3–5] These lesions are caused by repetitive microtrauma and degeneration of the tissue in conjunction with or without osteoarthritis (OA). The two pathologies, traumatic and degenerative, must be distinguished because of the fundamental differences in optimal management
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