Controversial role of arthroscopic meniscectomy of the knee: A review

The role of arthroscopic partial meniscectomy(APM) in reducing pain and improving function in patients with meniscal tears remains controversial. Five recent highquality randomized controlled trials(RCTs) compared non-operative management of meniscal tears to APM, with four showing no difference and one demonstrating superiority of APM. In this review, we examined the strengths and weaknesses of each of these RCTs, with particular attention to the occurrence of inadvertent biases. We also completed a quantitative analysis that compares treatment successes in each treatment arm, considering crossovers as treatment failures. Our analysis revealed that each study was an excellent attempt to compare APM with non-surgical treatment but suffered from selection, performance, detection, and/or transfer biases that reduce confidence in its conclusions. While the RCT remains the methodological gold standard for establishing treatment efficacy, the use of an RCT design does not in itself ensure internal or external validity. Furthermore, under our alternative analysis of treatment successes, two studies had significantly more treatment successes in the APM arm than the non-operative arm although original intention-totreat analyses showed no difference between these two groups. Crossovers remain an important problem in surgical trials with no perfect analytical solution. With the studies available at present, no conclusion can be drawn concerning the optimal treatment modality for meniscal tears. Further work that minimizes significant biases and crossovers and incorporates sub-group and cost-benefit analyses may clarify therapeutic indications.

Evaluation of the Early Functional Outcome Following Arthroscopic Partial Meniscectomy for Meniscal Tears

Meniscal tears are among the common knee pathologies which affect activities of daily living if not managed properly. Arthroscopic knee surgery is an evolving procedure in our environment and patient satisfaction with this procedure needs to be evaluated. This was a prospective study carried out between June 2017 and May 2018 with the aim to determine the effectiveness of Arthroscopic Partial Meniscectomy in the management of meniscal tears in our environment. The Western Ontario Meniscal Evaluation Tool (WOMET) Knee Score was used to assess patient satisfaction with this procedure. A total of thirty-one patients were recruited into the study consisting of eighteen males and thirteen females with an average age of thirteen years (17 - 48 years) who underwent arthroscopic partial meniscectomy. Preoperative and postoperative knee scores at 6 weeks and 12 weeks were compared using the Western Ontario Meniscal Evaluation Tool. At the end of the study period, data collated were analyzed using the specified tools. In terms of clinical outcomes, arthroscopic partial meniscectomy showed statistically significant improvement of symptoms as evidenced by a mean knee score of 75.6 (SD 9.3) at 6 weeks, 87.7 (SD 4.7) at 12 weeks compared with a preoperative knee score of 46.7. Medial meniscal tears were more common than lateral meniscal tears in all age groups and both sexes recruited into the study. The most common type of meniscal tear seen was the longitudinal type of tear while complex tear is the least type of tear seen. The surgery (arthroscopic partial meniscectomy) is an evolving area of sports medicine that requires sub-specialization, however solves the problem of increased mobility following open surgery. This study will tend to add to existing knowledge as patients who are mostly sports inclined can return to play very early with better outcome scores as regards pain and function.

Discoid meniscus:Treatment considerations and updates

A discoid meniscus is a morphological abnormality wherein the meniscus loses its normal‘C’shape.Although most patients are asymptomatic,patients might still present with symptoms such as locking,pain,swelling,or giving way.Magnetic resonance imaging is usually needed for confirmation of diagnosis.Based on a constellation of factors,including clinical and radiological,different approaches are chosen for the management of discoid meniscus.The purpose of this review is to outline the treatment of discoid meniscus,starting from conservative approach,to the different surgical options for this condition.The PubMed and Google Scholar databases were used for this review.Studies discussing the treatment of discoid meniscus from 2018 to 2023 were searched.Initially there were 369 studies retrieved,and after removal of studies using the exclusion criteria,26 studies were included in this review.Factors such as stability,presence of tear,and morphology can help with surgical planning.Many approaches have been used to treat discoid meniscus,where the choice is tailored for each patient individually.Postoperatively,factors that may positively impact patient outcomes include male sex,body mass index<18.5,age at symptom onset<25 years,and duration of symptoms<24 months.The conventional approach is partial meniscectomy with or without repair;however,recently,there has been an increased emphasis on discoid-preserving techniques such as meniscoplasty,meniscopexy,and meniscal allograft transplantation.

Torn discoid lateral meniscus treated with arthroscopic meniscectomy:observations in 62 knees

Background Discoid lateral meniscus of the knee is common in Chinese population. There has been considerable debate about the best treatment for discoid lateral meniscus tears. The purpose of this study was to observe the effect of arthroscopic meniscectomy for the treatment of discoid lateral meniscus tears. Methods Between July 1999 and December 2004, arthroscopic meniscectomy was performed on 62 menisci of 57 patients with discoid lateral meniscus tears （52 unilateral, 5 bilateral）. 41 menisci were ＂complete discoid meniscus＂, 21 =incomplete＂. According to the extent of the meniscus tears, partial meniscectomy was performed on 52 knees, total meniscectomy on 7 knees, and partial meniscectomy combined with meniscus suture on 3 knees through an arthroscope After the operations, early rehabilitation training programs, including straight-leg-raising and range-of-motion exercises, were carried out. 51 patients were followed up for 1 year 2 months to 6 years 5 months （mean, 3 years 3 months）, 6 patients were lost. Lysholm-Ⅱ scoring system was used to assess the function of the knee joints before the operation and during the follow-up. Results The operations on all the 62 knees were successful without complications. The patients could walk normally after completing the 2-week postoperation rehabilitation program. After 3-4 weeks they could lead a normal life and participate in a moderate amount of sports or other physical activities. The mean Lysholm-Ⅱ score was 89 （60--100） during the follow-up, which was significantly higher than that before the operation （50, range 34-74; P〈0.01）. 88% of the patients achieved excellent or good clinical results. Conclusions Arthroscopic meniscectomy is an alternative for treatment of discoid lateral meniscus tears with minimal traumatic effects. It can achieve early mobilization and a low complication rate, as well as the preservation of the meniscus structure and functions to the largest extent. In combination with proper rehabilitation training, the operation can lead to good or excellent results.

Treatment of meniscal tears: An evidence based approach

Treatment options for meniscal tears fall into three broad categories;non-operative,meniscectomy or meniscal repair.Selecting the most appropriate treatment for a given patient involves both patient factors(e.g.,age,co-morbidities and compliance)and tear characteristics(e.g.,location of tear/age/reducibility of tear).There is evidence suggesting that degenerative tears in older patients without mechanical symptoms can be effectively treated non-operatively with a structured physical therapy programme as a first line.Even if these patients later require meniscectomy they will still achieve similar functional outcomes than if they had initially been treated surgically.Partial meniscectomy is suitable for symptomatic tears not amenable to repair,and can still preserve meniscal function especially when the peripheral meniscal rim is intact.Meniscal repair shows 80%success at 2 years and is more suitable in younger patients with reducible tears that are peripheral(e.g.,nearer the capsular attachment)and horizontal or longitudinal in nature.However,careful patient selection and repair technique is required with good compliance to post-operative rehabilitation,which often consists of bracing and non-weight bearing for 4-6 wk.

Lessons Learned from a Case with Valgus Deformity of the Knee Following Partial Removal of Lateral Discoid Meniscus

Few studies have focused on the possible change in the axial alignment of the lower limb after lateral meniscectomy. Here, we present a patient with valgus deformity of the knee following the partial removal of lateral discoid meniscus. With the distal femur osteotomy and fixation, this complication was treated successfully. This case suggested that we should pay more attention to the axial alignment of the lower limb in patients with torn discoid lateral meniscus before meniscectomy, as a severe valgus inclination may develop in some of these patients.

Biosynthetic scaffolds for partial meniscal loss:A systematic review from animal models to clinical practice

Acute or degenerative meniscus tears are the most common knee lesions.Meniscectomy provides symptomatic relief and functional recovery only in the short-to mid-term follow-up but significantly increases the risk of osteoarthritis.For this reason,preserving the meniscus is key,although it remains a challenge.Allograft transplants present many disadvantages,so during the last 20 years preclinical and clinical research focused on developing and investigating meniscal scaffolds.The aim of this systematic review was to collect and evaluate all the available evidence on biosynthetic scaffolds for meniscus regeneration both in vivo and in clinical studies.Three databases were searched:46 in vivo preclinical studies and 30 clinical ones were found.Sixteen natural,15 synthetic,and 15 hybrid scaffolds were studied in vivo.Among them,only 2 were translated into clinic:the Collagen Meniscus Implant,used in 11 studies,and the polyurethane-based scaffold Actifit®,applied in 19 studies.Although positive outcomes were described in the short-to mid-term,the number of concurrent procedures and the lack of randomized trials are the major limitations of the available clinical literature.Few in vivo studies also combined the use of cells or growth factors,but these augmentation strategies have not been applied in the clinical practice yet.Current solutions offer a significant but incomplete clinical improvement,and the regeneration potential is still unsatisfactory.Building upon the overall positive results of these“old”technologies to address partial meniscal loss,further innovation is urgently needed in this field to provide patients better joint sparing treatment options.