Abstract
Purpose: A degenerative meniscus lesion is a slowly developing process typically involving a horizontal cleavage in a middle-aged or older person. When the knee is symptomatic, arthroscopic partial meniscectomy has been practised for a long time with many case series reporting improved patient outcomes. Since 2002, several randomised clinical trials demonstrated no additional benefit of arthroscopic partial meniscectomy compared to nonoperative treatment, sham surgery or sham arthroscopic partial meniscectomy. These results introduced controversy in the medical community and made clinical decision-making challenging in the daily clinical practice. To facilitate the clinical decision-making process, a consensus was developed. This initiative was endorsed by ESSKA. Methods: A degenerative meniscus lesion was defined as a lesion occurring without any history of significant acute trauma in a patient older than 35 years. Congenital lesions, traumatic meniscus tears and degenerative lesions occurring in young patients, especially in athletes, were excluded. The project followed the so-called formal consensus process, involving a steering group, a rating group and a peer-review group. A total of 84 surgeons and scientists from 22 European countries were included in the process. Twenty questions, their associated answers and an algorithm based on extensive literature review and clinical expertise, were proposed. Each question and answer set was graded according to the scientific level of the corresponding literature. Results: The main finding was that arthroscopic partial meniscectomy should not be proposed as a first line oftreatment for degenerative meniscus lesions. Arthroscopic partial meniscectomy should only be considered after a proper standardised clinical and radiological evaluation and when the response to non-operative management has not been satisfactory. Magnetic resonance imaging of the knee is typically not indicated in the first-line work-up, but knee radiography should be used as an imaging tool to support a diagnosis of osteoarthritis or to detect certain rare pathologies, such as tumours or fractures of the knee. Discussion: The present work offers a clear framework for the management of degenerative meniscus lesions, with the aim to balance information extracted from the scientific evidence and clinical expertise. Because of biases and weaknesses of the current literature and lack of definition of important criteria such as mechanical symptoms, it cannot be considered as an exact treatment algorithm. It summarises the results of the ESSKA Meniscus Consensus Project (http://www.esska.org/education/projects) and is the first official European consensus on this topic. The consensus may be updated and refined as more high-quality evidence emerges. Level of evidence: I. (Less)
Highlights
Degenerative meniscus lesions (DMLs) develop slowly and typically involve a horizontal cleavage of the meniscus in middle-aged or older persons
There is a clear correlation between knee osteoarthritis and meniscus degeneration, it is sometimes difficult to establish a clear line of distinction between these two entities
A DML was defined as a meniscus lesion occurring without a history of a knee trauma in a patient older than 35 years
Summary
Degenerative meniscus lesions (DMLs) develop slowly and typically involve a horizontal cleavage of the meniscus in middle-aged or older persons. Magnetic resonance imaging (MRI) will typically identify a linear intrameniscus signal [18], often communicating with the articular surface This hypersignal is reported to be the result of ongoing mucoid degenerative changes. A degenerative meniscus lesion is a slowly developing lesion, typically involving a horizontal cleavage of the meniscus in a middle-aged or older person Such meniscus lesions are frequent in the general population and are often incidental findings on knee MRI (Fig. 2). A degenerative meniscus lesion is usually characterised by linear intrameniscus MRI signal (including a component with horizontal pattern) often communicating with the inferior meniscus surface on at least two image slices. The most common location of a degenerative meniscus lesion is the body and (or) posterior horn of the medial meniscus (Grade B)
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