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. 2025 Apr;33(4):1259-1269.
doi: 10.1002/ksa.12493. Epub 2024 Oct 24.

The management of isolated meniscal tears in skeletally immature children. An international expert consensus

Matthew Hampton  1   2 , Fazal Ali  2 , Nicolas Nicolaou  2 , Adil Ajuied  3 ; Paediatric Meniscal Working Group
Collaborators, Affiliations

The management of isolated meniscal tears in skeletally immature children. An international expert consensus

Matthew Hampton et al. Knee Surg Sports Traumatol Arthrosc. 2025 Apr.

Abstract

Purpose: The prevalence and appreciation of meniscal tears in children have increased in both number and complexity. There is currently a paucity of high-quality evidence that can guide surgeons in treating skeletally immature patients with meniscal injuries. The aim of this study was to develop comprehensive recommendations for the management of isolated meniscal tears in skeletally immature children.

Methods: An international, two-round, modified Delphi consensus was completed. Included 'experts' were identified as having an established adult knee practice, including children and either: (1) Faculty at an international paediatric knee conference, (2) Active members of complex national paediatric multi-disciplinary groups or (3) Members of faculty on recognised national/international instructional courses aimed at teaching the management of meniscal lesions to knee surgeons. The currently available literature was reviewed, and areas of poor quality, inconclusive or absent evidence were examined and formed the focus of the study. A threshold of 70% was used to define consensus for our study based on other similar Delphi consensus studies in the literature.

Results: A total of 43 experts (Round 1) and 41 experts (Round 2) took part in the Delphi study, including surgeons from Europe, the United States of America and South America. 34 statements were identified exploring three main domains-clinical assessment, management and complex tears (bucket handle, discoid and radial). Following Round 1, consensus was reached on 17 (50%) statements; subsequently, after completion of Round 2, consensus was reached on 28 (82%) statements, leaving six (18%) with no consensus. The areas of no consensus included investigation of painless clicking, the most sensitive clinical test for meniscal pathology, treatment of small radial tears (less than 1/3 width), ability to reduce chronic bucket handle tears and timing of surgery.

Conclusions: This is the first modified Delphi consensus that provides evidence for surgeons treating skeletally immature children with isolated meniscal tears. A valuable level of consensus was reached on the assessment and management of simple and specialist meniscal tears. These consensus statements can both inform clinical practice and be used in the development of further high-quality research studies.

Level of evidence: Level V.

Keywords: children; consensus; meniscal repair; meniscus.

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References

REFERENCES

    1. Abram, S.G.F., Judge, A., Beard, D.J. & Price, A.J. (2018) Adverse outcomes after arthroscopic partial meniscectomy: a study of 700 000 procedures in the national hospital episode statistics database for England. The Lancet, 392(10160), 2194–2202. Available from: https://doi.org/10.1016/S0140-6736(18)31771-9
    1. Andrish, J.T. (1996) Meniscal injuries in children and adolescents: diagnosis and management. Journal of the American Academy of Orthopaedic Surgeons, 4, 231–237. Available from: https://doi.org/10.5435/00124635-199609000-00001
    1. Beatrice Tan, J.N. & James Loh, S.Y. (2021) An approach to chronic and displaced bucket handle meniscal tear‐assessment, repair (Push‐and‐Pull Technique), or salvage. Arthroscopy Techniques, 10(7), e1853–e1857. Available from: https://doi.org/10.1016/j.eats.2021.04.005
    1. Blanchard, E.R., Hadley, C.J., Wicks, E.D., Emper, W. & Cohen, S.B. (2020) Return to play after isolated meniscal repairs in athletes: a systematic review. Orthopaedic Journal of Sports Medicine, 8(11), 2325967120962093. Available from: https://doi.org/10.1177/2325967120962093
    1. Chapman‐Jones, D., Paterson, A. & Johnston, S. (1998) Plain radiography of the knee: a useful diagnostic modality for patients with non‐specific knee pain? Radiography, 4(3), 183–187. Available from: https://doi.org/10.1016/S1078-8174(98)80044-8

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