Meniscectomy is still a frequent orthopedic procedure: a pending need for education on the meniscus treatment possibilities

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Abstract

Purpose

The purpose of this study was to evaluate the current status of education of polish surgeons in the subject of meniscus repair possibilities. The analysis of the possible correlations between the number of knee arthroscopy procedures performed by polish surgeons and their decision whether to remove or to repair the damaged meniscus has been performed.

Methods

Two-hundred and five registered orthopedic surgeons took part in surveys. The questionnaire contained the description of 20 patients with different types of meniscus damage and three questions concerning the experience in knee arthroscopy (two questions) and a choice of the treatment method (one question). Comparisons were made between knee arthroscopy experts (> 100 arthroscopies performed per year) and non-experts (≤ 100 cases).

Results

The questionnaire was completed by 194 knee surgeons from Poland with different levels in knee arthroscopy experience. For most cases, experts and non-experts agreed on the meniscus treatment method. Statistically significant differences in the recommended treatment between experts and non-experts were observed in 4 cases, where experts decided to repair the damage rather than to perform the meniscectomy.

Conclusions

Meniscectomy remains a frequent orthopedic procedure, despite meniscal sparing having been advocated for several decades now and despite the existence of meniscus repair technique which gives good clinical outcomes—augmentation of the damaged meniscus with a collagen membrane. Polish surgeons still need education on the meniscus treatment possibilities.

Level of evidence

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Most cited references 23

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Meniscal root tears: significance, diagnosis, and treatment.

Sanjeev Bhatia, Christopher LaPrade, Michael B Ellman … (2014)

Meniscal root tears, less common than meniscal body tears and frequently unrecognized, are a subset of meniscal injuries that often result in significant knee joint disorders. The meniscus root attachment aids meniscal function by securing the meniscus in place and allowing for optimal shock-absorbing function in the knee. With root tears, meniscal extrusion often occurs, and the transmission of circumferential hoop stresses is impaired. This alters knee biomechanics and kinematics and significantly increases tibiofemoral contact pressure. In recent years, meniscal root tears, which by definition include direct avulsions off the tibial plateau or radial tears adjacent to the root itself, have attracted attention because of concerns that significant meniscal extrusion dramatically inhibits normal meniscal function, leading to a condition biomechanically similar to a total meniscectomy. Recent literature has highlighted the importance of early diagnosis and treatment; fortunately, these processes have been vastly improved by advances in magnetic resonance imaging and arthroscopy. This article presents a review of the clinically relevant anatomic, biomechanical, and functional descriptions of the meniscus root attachments, as well as current strategies for accurate diagnosis and treatment of common injuries to these meniscus root attachments.

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

Ph Beaufils, R O Becker, S Kopf … (2017)

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.

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Trends in meniscus repair and meniscectomy in the United States, 2005-2011.

Geoffrey Abrams, Rachel Frank, Anil Gupta … (2013)

Meniscus deficiency may lead to degenerative arthritis in the knee. There is a significant emphasis on meniscus preservation, particularly in the young patient, to reduce the risk of arthritis. To report on the incidence of meniscus repair and meniscectomy, with and without concomitant anterior cruciate ligament (ACL) reconstruction, in the United States (US) over the past 7 years. Descriptive epidemiology study. Patients who underwent arthroscopic meniscectomy (Current Procedural Terminology [CPT] codes 29880 and 29881), meniscus repair (CPT codes 29882 and 29883), and ACL reconstruction (CPT code 29888) for the years 2005 through 2011 were identified using the PearlDiver Patient Record Database. Age group and sex were collected for each patient. Patient groups included meniscectomy alone, meniscus repair alone, meniscus repair followed by meniscectomy, ACL reconstruction with concomitant meniscus repair, and ACL reconstruction with concomitant meniscus repair followed by meniscectomy. Linear regression and Student t tests were utilized for comparisons, with an α value of .05 set as significant. The database represented approximately 9% of the US population under 65 years of age. There was no significant change in the number of patients in the covered population during the study time frame (P = .138). From 2005 to 2011, there were a total of 387,833 meniscectomies, 23,640 meniscus repairs, and 84,927 ACL reconstructions. There was a significant increase in the total number of isolated meniscus repairs performed (P = .001) and a doubling of the incidence of repairs from 2005 to 2011. There was no significant increase in the total number of meniscectomies performed (P = .712), while the incidence of meniscectomies increased only 14% from 2005 to 2011. There was no significant change in the number of meniscus repairs performed at the same time as ACL reconstruction during the study time frame. The total number and incidence of meniscectomies after repair with and without ACL reconstruction significantly decreased. There has been an increased number of isolated meniscus repairs being performed in the US over the past 7 years without a concomitant increase in meniscectomies over the same time frame. These data suggest that meniscus repairs are preferentially being performed over meniscectomies.

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Author and article information

Contributors

Paweł Bąkowski: pawel.bakowski@rehasport.pl

Kamilla Bąkowska-Żywicka: kamilla.bakowska-zywicka@rehasport.pl

Journal

Journal ID (nlm-ta): Knee Surg Sports Traumatol Arthrosc

Journal ID (iso-abbrev): Knee Surg Sports Traumatol Arthrosc

Title: Knee Surgery, Sports Traumatology, Arthroscopy

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 0942-2056

ISSN (Electronic): 1433-7347

Publication date (Electronic): 4 June 2021

Publication date PMC-release: 4 June 2021

Publication date (Print): 2022

Volume: 30

Issue: 4

Pages: 1430-1435

Affiliations

[1 ]GRID grid.452699.5, Department of Orthopedic Surgery, , Rehasport Clinic, ; Górecka Street 30, 60-201 Poznan, Poland

[2 ]GRID grid.418855.5, ISNI 0000 0004 0631 2857, Institute of Bioorganic Chemistry Polish Academy of Sciences, ; Noskowskiego 12/14, 61-704 Poznan, Poland

[3 ]GRID grid.22254.33, ISNI 0000 0001 2205 0971, Department of Spine Disorders and Pediatric Orthopedics, , University of Medical Sciences, ; Poznan, Poland

Article

Publisher ID: 6612

DOI: 10.1007/s00167-021-06612-w

PMC ID: 9007761

PubMed ID: 34086095

SO-VID: 4abc5b07-14ff-4ee8-8f0b-896c5f27385d

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 19 January 2021

Date accepted : 17 May 2021

Custom metadata

issue-copyright-statement © The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2022

ScienceOpen disciplines: Surgery

Keywords: knee arthroscopy,meniscus repair,survey,surgical expertise

Data availability:

ScienceOpen disciplines: Surgery

Keywords: knee arthroscopy, meniscus repair, survey, surgical expertise

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Meniscectomy is still a frequent orthopedic procedure: a pending need for education on the meniscus treatment possibilities

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Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Related collections

SICOT-J (Orthopedic surgery and traumatology)

Most cited references 23

Meniscal root tears: significance, diagnosis, and treatment.

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

Trends in meniscus repair and meniscectomy in the United States, 2005-2011.

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Cited by 6

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