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Surgical management of degenerative meniscus lesions : The 2016 ESSKA meniscus consensus

Beaufils, Ph; Becker, Rolf; Kopf, S.; Englund, M. LU ; Verdonk, Robert C.; Ollivier, Morgane and Seil, R. (2017) In Arthroskopie 30(2). p.128-137
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 non-operative 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... (More)

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 non-operative 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. 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 of treatment 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. MRI 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 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, it cannot be considered as an exact treatment algorithm. It summarises the results of the “ESSKA Meniscus Consensus Project” 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.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Arthroscopic partial meniscectomy, Consensus, Degenerative Lesion, Management, Meniscus
in
Arthroskopie
volume
30
issue
2
pages
10 pages
external identifiers
  • scopus:85018468009
ISSN
0933-7946
DOI
10.1007/s00142-017-0129-y
language
English
LU publication?
yes
id
6552b7b3-8056-49cc-86b7-5eb7e05e0982
date added to LUP
2017-05-19 09:57:21
date last changed
2017-09-20 10:46:27
@article{6552b7b3-8056-49cc-86b7-5eb7e05e0982,
  abstract     = {<p>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 non-operative 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. 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 of treatment 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. MRI 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 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, it cannot be considered as an exact treatment algorithm. It summarises the results of the “ESSKA Meniscus Consensus Project” 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.</p>},
  author       = {Beaufils, Ph and Becker, Rolf and Kopf, S. and Englund, M. and Verdonk, Robert C. and Ollivier, Morgane and Seil, R.},
  issn         = {0933-7946},
  keyword      = {Arthroscopic partial meniscectomy,Consensus,Degenerative Lesion,Management,Meniscus},
  language     = {eng},
  month        = {04},
  number       = {2},
  pages        = {128--137},
  series       = {Arthroskopie},
  title        = {Surgical management of degenerative meniscus lesions : The 2016 ESSKA meniscus consensus},
  url          = {http://dx.doi.org/10.1007/s00142-017-0129-y},
  volume       = {30},
  year         = {2017},
}