Degenerative meniscal lesions: Conservative versus surgical management

INTRODUCTION: Degenerative meniscal lesion (DML) typically occur in middle-aged patients without any history of significant acute trauma. Its prevalence increases with age and are associated with knee osteoarthritis (OA). The most frequent orthopedic treatment is arthroscopic partial meniscectomy (APM) to relieve pain and functional deficit associated with DML. The aim of the present narrative review is to focus on the guidelines of DML treatment in middle aged patients. METHODS: A review was conducted of PubMed articles from January 1, 2000 to December 31, 2020 using a combination of the following keywords: knee, osteoarthritis, degenerative meniscal lesion, degenerative meniscal tear, and arthroscopic partial meniscectomy. RESULTS: A total of 12 papers were included in the present narrative review. Of these, 3 papers assessed the clinical outcome of patients with DML treated conservatively and 9 papers compared the clinical outcome of patients with DML, with or without mechanical symptoms, treated with APM versus conservative therapy or APM versus sham surgery. DISCUSSION: International guidelines recommend that DML in the presence of knee OA should be managed by conservative therapy rather than APM. Recent studies have demonstrated that even in the absence of radiographic signs of knee OA, with or without mechanical symtoms, there was no advantage of APM over conservative therapy of patients with DML. Moreover, APM offer no further advantage for knee symptoms or function compared with sham surgery. Numerous predictive factors of poor results after APM for DML have been identified in the current literature including age at surgery, female sex, obesity, meniscal extrusion, duration of the clinical symptoms, bone marrow edema, a low pre-operative score, complex meniscal lesions, larger meniscectomy, lateral meniscectomy advanced cartilage injuries and misalignment. CONCLUSION: Many randomized controlled clinical trials recommend against APM as the first-line treatment for managing knee pain in patients affected by DML and no radiographic knee OA that should be reserved for cases of failure after 3 month conservative therapy or earlier in patients with major knee mechanical symptoms. Nevertheless, surgeons should inform patients that APM in the presence of negative prognostic factors is associated with poor clinical outcome. (www.actabiomedica.it)