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Purpose of Review: Given the continued controversy among orthopedic surgeons regarding the indications and benefits of arthroscopic partial meniscectomy (APM), this review summarizes the current literature, indications, and outcomes of partial meniscectomy to treat symptomatic meniscal tears. Recent Findings: In patients with symptomatic meniscal tears, the location and tear pattern play a vital role in clinical management. Tears in the central white-white zone are less amenable to repair due to poor vascularity. Patients may be indicated for APM or non-surgical intervention depending on the tear pattern and symptoms. Non-surgical management for meniscal pathology includes non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy (PT), and intraarticular injections to reduce inflammation and relieve symptoms. There have been several landmark multicenter randomized controlled trials (RCTs) studying the outcomes of APM compared to PT or sham surgery in symptomatic degenerative meniscal tears. These most notably include the 2013 Meniscal Tear in Osteoarthritis Research (MeTeOR) Trial, the 2018 ESCAPE trial, and the sham surgery-controlled Finnish Degenerative Meniscal Lesion Study (FIDELITY), which failed to identify substantial benefits of APM over nonoperative treatment or even placebo surgery. Summary: Despite an abundance of literature exploring outcomes of APM for degenerative meniscus tears, there is little consensus among surgeons about the drivers of good outcomes following APM. It is often difficult to determine if the presenting symptoms are secondary to the meniscus pathology or the degenerative disease in patients with concomitant OA. A central tenet of managing meniscal pathology is to preserve tissue whenever possible. Most RCTs show that exercise therapy may be non-inferior to APM in degenerative tears if repair is not possible. Given this evidence, patients who fail nonoperative treatment should be counseled regarding the risks of APM before proceeding to surgical management. [ABSTRACT FROM AUTHOR]

Purpose: No comparative studies of outcomes between degenerative medial meniscus posterior root tear (MM PRT) and non-root tear (NRT) have been conducted. This study aimed to compare joint survival and clinical outcome between MM PRT and MM NRT after partial meniscectomy with proper control of confounding factors.Methods: One hundred and ten patients each in MM PRT and MM NRT groups who underwent arthroscopic partial meniscectomy were retrospectively evaluated through propensity score matching. Joint survival was assessed on the basis of surgical and radiographic failures. Clinical outcomes were assessed using the Lysholm score.Results: The confounding variables were well balanced between the groups, with standardized mean differences of < 0.2 after propensity score matching. Failures occurred in 30 (27.3%) and 35 patients (31.8%) in the MM PRT group and MM NRT group, respectively. The estimated mean survival times were 12.5 years (95% confidence interval [CI] 11.5-13.5) and 11.7 years (10.7-12.7), respectively. There were no significant differences in the overall survival rate and Lysholm score between the two groups (n.s.).Conclusion: In middle-aged patients with degenerative MM PRT, joint survival and clinical outcome showed comparable results with those with MM NRT after partial meniscectomy. Arthroscopic partial meniscectomy is one of the effective treatments for MM PRT with consideration of various patient factors.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

Purpose: Adductor canal block (ACB) provides postoperative pain relief as effectively as femoral nerve block (FNB) does, and it preserves the strength of the quadriceps femoris. However, its effect on rehabilitation after arthroscopic partial meniscectomy has not been reported. The purpose of this study was to determine the effect of pre-operative ACB and FNB on the quality of rehabilitation after arthroscopic partial meniscectomy.Methods: A total of 150 patients undergoing arthroscopic partial meniscectomy were randomly allocated to the FNB group (receiving 0.3% ropivacaine 30 ml at the thighroot-femoral nerve), the ACB group (receiving 0.3% ropivacaine 30 ml at mid-thigh adductor canal), or the control group. The primary outcome was the Hospital for Special Surgery (HSS) knee score on the 30th postoperative day.Results: The HSS knee score of the ACB group on the 30th day after the operation was significantly higher than those of the FNB and control groups (88.6 ± 5.3 vs. 85.3 ± 6.9 and 81.2 ± 5.9, respectively; P < 0.05). Both the ACB and FNB groups showed excellent rehabilitation, indicating similar rehabilitation quality for both treatments.Conclusion: ACB is similar to FNB concerning the quality of rehabilitation and pain relief after arthroscopic partial meniscectomy, while ACB has little effect on the strength of the quadriceps femoris.Level Of Evidence: I TRIAL REGISTRATAION: This trial was registered in the Chinese Clinical Trial Registry (ChiCTR-INC-16008346). [ABSTRACT FROM AUTHOR]

Purpose: To identify the prognostic factors for 2-year patient-reported outcomes in middle-aged patients with degenerative meniscal tears treated with exercise therapy (ET) or arthroscopic partial meniscectomy (APM).Methods: One hundred and seven patients, with mean age 49.6 (SD 6.2) years and BMI 25.7 (SD 3.7), were included in this analysis of data from the OMEX trial ( http://www.clinicaltrials.gov NCT01002794). Linear and Poisson regression models were built to explore the associations between potential prognostic factors (patient characteristics, knee function-related and disease-related factors) and 2-year patient-reported outcomes: the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales Pain, Symptoms, ADL, Sport/Rec, QoL and 5-point Global Rating of Change scales for knee pain (GRC Pain) and function (GRC Function). Analyses were performed for the whole cohort and for the two treatment groups (n = 55 and 52) with adjustments for age, sex, BMI and baseline KOOS.Results: For the whole cohort, a 1-s better baseline 6-m timed hop test result was associated with 3.1-7.1 points better 2-year scores for all KOOS subscales (95% CIs 1.1-5.2 to 4.1-10.1 points). A 1.61-2.80 s better test was associated with scores equivalent to previously calculated clinical relevant differences for each KOOS subscale. For the groups of patients treated with ET and APM, respectively, 2.09-3.60 s and 0.63-1.99 s better tests were associated with clinical relevant differences. For the whole cohort, a 1-s better test was associated with 26% (95% CI 15-38%) and 22% (95% CI 11-34%) higher possibility for better or much better GRC Pain and Function scores. Patients treated with ET had 17% (95% CI 2-33%) increased possibility for better or much better GRC Pain score, and patients treated with APM had 65% (95% CI 32-108%) and 70% (95% CI 38-109%) increased possibility for better or much better GRC Pain and Function scores.Conclusions: The 6-m timed hop test result was a significant prognostic factor for 2-year patient-reported outcomes in middle-aged patients with degenerative meniscal tears, especially in those treated with APM.Level Of Evidence: II. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the influence of meniscal tear pattern on clinical outcomes following arthroscopic partial meniscectomy in middle-aged patients with medial meniscal tears.Methods: A total of 123 patients (130 knees) aged ≥ 50 years who underwent arthroscopic partial meniscectomy for medial meniscal tears were evaluated. Inclusion criteria were none to moderate medial knee osteoarthritis [Kellgren-Lawrence (KL) grade ≤ 3] and a minimum of 2-year follow-up (median 4.6 years; range 2.1-8.0 years). Meniscal tears observed during arthroscopic examination were classified into six types: radial tear of the middle segment, posterior root tear, horizontal tear of the posterior segment, flap tear, minor tear, and complex tear. Postoperative outcomes were classified into effective (group 1) and non-effective (group 2) according to the pain relief administered 1 month postoperatively and at the final follow-up. Demographic variables, KL grade, type of meniscal tear, and postoperative follow-up period were evaluated.Results: Forty knees (38%) were classified into group 1. Of the six types of tears, radial tear of the middle segment [odds ratio (OR) 4.1, 95% confidence interval (CI) 1.1-20.9] and flap tear (OR 12.9, 95% CI 1.8-140.7) were significant predictors of good outcome on multivariate logistic regression analysis.Conclusions: In middle-aged patients with medial meniscal tears, radial tear of the middle segment was independently associated with less pain following arthroscopic meniscectomy. Arthroscopic partial meniscectomy may be indicated in patients with radial tear if conservative treatment fails.Level Of Evidence: Case-control study, Level III. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to examine the long-term clinical outcomes of arthroscopic partial meniscectomy for the treatment of discoid lateral meniscus in children.Methods: A previous study identified 34 consecutive patients that underwent arthroscopic meniscal saucerization by one of the two surgeons between 1997 and 2002. Patients were asked to complete several outcomes questionnaires and were given the opportunity to receive a knee exam performed by their treating surgeon.Results: Of the 34 eligible patients, 21 agreed to participate. Seventeen patients (19 knees) had greater than 2-year follow-up, with an average follow-up of 11.0 years (range 3.4-16.6 years). Average age at the time of surgery was 9.3 years. Average IKDC, Kujala, and Lysholm scores at follow-up were 82.8 ± 28.9, 86.6 ± 15.2, and 83.7 ± 18.6, respectively. In addition, median Marx and Tegner scores were 5 (range 0-14) and 6 (range 3-8), respectively. Stratifying the Lysholm scores revealed outcomes that were 45.4% "excellent", 16.7% "good", 25.0% "fair", and 16.7% "poor". In total, 36.8% (7 of 19) of knees underwent at least one subsequent surgical procedure. There were no significant associations between outcome scores and discoid type, meniscal stability, location of instability, or age at time of surgery.Conclusions: The results of the current study suggest that clinical outcome scores decline over time in patients treated arthroscopically for symptomatic discoid meniscus. Compared to our previous study with 2-year follow-up, there is an increased incidence of knee pain and mechanical/functional limitations. The overall modest, long-term results of this study illustrate the need for improved operative treatments for symptomatic discoid meniscus in children to prevent progressive, long-term clinical decline in these patients. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study is to evaluate mid-to-long-term clinical and radiological outcomes after an arthroscopic partial meniscectomy for symptomatic discoid lateral meniscus (DLM) in young patients and to determine whether degeneration of the residual meniscus and articular cartilage progresses during the follow-up period using magnetic resonance imaging (MRI).Materials and Methods: We retrospectively reviewed patients aged ≤ 40 years at surgery who underwent arthroscopic partial meniscectomy for symptomatic DLM and were followed up for ≥ 5 years. Lysholm knee scores and reoperation rates were assessed as clinical outcomes. Factors that affect clinical outcomes were evaluated. Tapper-Hoover classification and femorotibial angle were used for radiological assessment. The degree of degeneration of articular cartilages and residual meniscus was evaluated using preoperative and follow-up MRIs.Results: A total of 73 knees (66 patients) were enrolled. The mean follow-up period was 10.0 years. The mean follow-up Lysholm knee score was 84.2 ± 14.5, and the reoperation rate was 32.9%. Follow-up Lysholm knee scores were related to duration of symptoms prior to surgery (β = - 0.129, P = 0.003) and femorotibial angle at the last follow-up (β = 1.362, P = 0.045). On simple radiographs, progression of arthritis of the lateral compartment was observed in 68.5% (49 knees). In MRI analyses, degeneration of the residual meniscus progressed in 52.9% (34 knees) (P < 0.001), and significant changes in modified Yulish scores were observed in both lateral femoral and tibial condyles (P < 0.001, both condyles).Conclusions: After an arthroscopic partial meniscectomy for symptomatic DLM, unfavorable clinical outcomes were shown in > 30% of the patients during a mean follow-up of 10.0 years. Clinical outcomes based on the patient-reported outcome measures were related to durations of symptoms prior to surgery and alignment at the last follow-up. In radiological and MRI assessments, progression of degeneration of articular cartilages in the lateral compartments of the knees and residual menisci was observed. [ABSTRACT FROM AUTHOR]

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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, 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 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. 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. [ABSTRACT FROM AUTHOR]

This retrospective study was aimed to investigate the epidemiologic, clinical and arthroscopic features of discoid meniscus variant in Greek population. We reviewed the cases of 2,132 patients who underwent knee arthroscopy between 1986 and 2004 and diagnosis of discoid lateral meniscus was established in 39 patients with mean age of 31.7 ± 9.4 years old. Incidence of the discoid lateral meniscus variant was recorded at rate of 1.8% presenting no significant differences according to patient gender or lesion body side. Regarding the type of discoid dysmorphy, 23 cases attributed to complete type, 15 were incomplete and in one case, Wrisberg type was observed. Predictive values of the most commonly recorded physical signs in the clinical diagnosis of the discoid meniscus were analysed. Comparative evaluation of the long-term results of arthroscopic partial meniscectomy performed in patients with intact or torn discoid lateral meniscus and torn normally shaped lateral meniscus was carried out using Lysholm and IKDC scoring systems. Also, we investigated any correlation between dysmorphy type and tear pattern analysing the arthroscopic findings. Results demonstrated that the discoid meniscus lesion represents an atypical clinical entity in adults and no significant predictive value of the signs encountered in the clinical examination of the patients with discoid meniscus was observed. Clinical outcome after arthroscopic partial meniscectomy regarding the intact discoid meniscus group was superior in comparison with that of torn discoid meniscus cases. On other hand, no difference in the result of partial meniscectomy between discoid and normal lateral meniscus tear groups was found. No statistically significant relationship between the type of discoid menisci and tear pattern or incidence rate of concomitant intraarticular lesions was confirmed. [ABSTRACT FROM AUTHOR]

A new method of arthroscopic partial meniscectomy for horizontal tear of discoid lateral meniscus was devised to preserve as much meniscal tissue as possible. To evaluate the clinical result of this method for horizontal tear of discoid lateral meniscus, 31 knees (30 patients) were reviewed at an average follow-up of 35 months (range 14-48 months). Horizontally torn discoid lateral menisci were classified as incomplete (11 cases) or complete (20 cases) by the Watanabe classification; no Wrisberg type was noted. Partial meniscectomy was performed in all cases. For the technique of a new method of partial meniscectomy, the unstable leaf of the horizontally torn meniscus was removed to the peripheral rim, but the stable one was preserved and reshaped to produce the similar appearance to the normal lateral meniscus in terms of width and thickness. It was trimmed to have a balanced rim of meniscal tissue about 6-8 mm in width. Meniscal repair was added to partial meniscectomy in one case. All the cases were rated using the Lysholm Knee Scoring Scale and were reviewed to recognize retear clinically. The scores increased after partial meniscectomy by average 20.7 (from 73.0 to 93.7). Recurrence of tear or aggravation of symptoms was not noted at the final follow-up. [ABSTRACT FROM AUTHOR]