Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Oct;15(5):336-343.
doi: 10.1007/s12178-022-09770-7. Epub 2022 Jun 21.

Current Controversies in Arthroscopic Partial Meniscectomy

Amanda Avila  1 , Kinjal Vasavada  2 , Dhruv S Shankar  2 , Massimo Petrera  2 , Laith M Jazrawi  2 , Eric J Strauss  2
Affiliations
Review

Current Controversies in Arthroscopic Partial Meniscectomy

Amanda Avila et al. Curr Rev Musculoskelet Med. 2022 Oct.

Abstract

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. 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.

Keywords: Arthroscopic partial meniscectomy; Degenerative tear; Meniscal tear; Osteoarthritis; Physical therapy; Sham surgery; Traumatic tear.

PubMed Disclaimer

Conflict of interest statement

Amanda Avila declares that she has no conflict of interest.

Kinjal Vasavada declares that she has no conflict of interest.

Dhruv Shankar declares that he has no conflict of interest.

Laith M. Jazrawi has received consulting fees from Flexion Therapeutics; research support from Arthrex, Mitek, and Smith & Nephew; and education support from Gotham Surgical and Arthrex.

Eric J Strauss has received consulting fees from Arthrex, Fidia, Flexion Therapeutics, the Joint Restoration Foundation, Organogenesis, Smith & Nephew, Subchondral Solutions, and Vericel; research support from Fidia, Organogenesis, and CartiHeal.

Figures

Fig. 1
Fig. 1
Preoperative MRI showing horizontal component of complex medial meniscus tear denoted by yellow arrow
Fig 2
Fig 2
a View from the anterolateral viewing portal showing a complex tear of the medial meniscus. b View of the complex tear following the meniscectomy. c View from the anteromedial viewing portal showing a cleavage tear of the lateral meniscus. d View of the cleavage tear following the meniscectomy
See this image and copyright information in PMC

References

    1. Fithian DC, Kelly MA, Mow VC. Material properties and structure-function relationships in the menisci. Clin Orthop Relat Res. 1990;252:19–31. doi: 10.1097/00003086-199003000-00004. - DOI - PubMed
    1. Englund M, Guermazi A, Lohmander SL. The role of the meniscus in knee osteoarthritis: a cause or consequence? Radiol Clin N Am. 2009;47(4):703–712. doi: 10.1016/j.rcl.2009.03.003. - DOI - PubMed
    1. Logerstedt DS, Snyder-Mackler L, Ritter RC, Axe MJ, Godges J. Knee pain and mobility impairments: meniscal and articular cartilage lesions. J Orthop Sports Phys Ther. 2010;40(6):A1–597. doi: 10.2519/jospt.2010.0304. - DOI - PMC - PubMed
    1. Molina CS, Thakore RV, Blumer A, Obremskey WT, Sethi MK. Use of the national surgical quality improvement program in orthopaedic surgery. Clin Orthop Relat Res. 2015;473(5):1574–1581. doi: 10.1007/s11999-014-3597-7. - DOI - PMC - PubMed
    1. Sihvonen R, Paavola M, Malmivaara A, Itälä A, Joukainen A, Kalske J, et al. Arthroscopic partial meniscectomy for a degenerative meniscus tear: a 5 year follow-up of the placebo-surgery controlled FIDELITY (Finnish Degenerative Meniscus Lesion Study) trial. Br J Sports Med. 2020;54(22):1332–1339. doi: 10.1136/bjsports-2020-102813. - DOI - PMC - PubMed