Practice Guideline

. 2025 Aug;33(8):3014-3024.

doi: 10.1002/ksa.12689. Epub 2025 Jun 12.

The formal EU-US Meniscus Rehabilitation 2024 Consensus: An ESSKA-AOSSM-AASPT initiative. Part II-Prevention, non-operative treatment and return to sport

Robert Prill^{1

2}, C Benjamin Ma³, Stephanie E Wong³, Philippe Beaufils⁴, Juan Carlos Monllau^{5

6}, Elanna K Arhos⁷, Roland Becker^{1

2}, Francesco Della Villa⁸, J Brett Goodloe⁹, James J Irrgang¹⁰, Jitka Klugarova¹¹, Emma L Klosterman¹², Aleksandra Królikowska¹³, Aaron J Krych¹⁴, Robert F LaPrade¹⁵, Robert Manske¹⁶, Nicky van Melick¹⁷, Jill K Monson¹⁵, Marko Ostojic¹⁸, Mark V Paterno^{19

20}, Tomasz Piontek²¹, Simone Perelli⁶, Alexandre Rambaud²², James Robinson²³, Laura C Schmitt²⁴, Eric Hamrin Senorski²⁵, Thorkell Snaebjornsson²⁶, Adam J Tagliero¹⁴, Airelle O Giordano²⁷, Nicolas Pujol²⁸

Affiliations

¹ Department of Orthopedics and Traumatology, Brandenburg Medical School Theodor Fontane, University Hospital Brandenburg/Havel, Brandenburg an der Havel, Germany.
² Brandenburg Medical School Theodor Fontane, Faculty of Health Sciences Brandenburg, Brandenburg an der Havel, Germany.
³ Department of Orthopaedic Surgery, University of California, San Francisco, California, USA.
⁴ Centre Médical, ESSKA Office, Luxembourg.
⁵ Department of Orthopedics and Traumatology, Hospital del Mar, Barcelona, Spain.
⁶ Universitat Autònoma de Barcelona, Institut Català de Traumatologia i Medicina del'Esport (ICATME) - Hospital Universitari Dexeus, Knee and Arthroscopy Unit, Barcelona, Spain.
⁷ Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, USA.
⁸ Isokinetic Medical Group, FIFA Medical Centre of Excellence, Education & Research Department, Bologna, Italy.
⁹ Department of Orthopedic Surgery, VCU Health, Richmond, Virginia, USA.
¹⁰ Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania, USA.
¹¹ Cochrane Czech Republic, Czech CEBHC: JBI Centre of Excellence, Czech GRADE Network, Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic.
¹² Department of Orthopaedic Surgery, Michigan Medicine, Ann Arbor, Michigan, USA.
¹³ Physiotherapy Research Laboratory, University Centre of Physiotherapy and Rehabilitation, Faculty of Physiotherapy, Wroclaw Medical University, Wroclaw, Poland.
¹⁴ Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
¹⁵ Twin Cities Orthopedics, Edina and Eagan, Minnesota, USA.
¹⁶ Wichita State University, Ascension Via Christi, Wichita, Kansas, USA.
¹⁷ Sports & Orthopedics Research Center, Anna TopSupport, Eindhoven, The Netherlands.
¹⁸ Osteon Orthopedics and Sports Medicine Clinic, Mostar, Bosnia and Herzegovina.
¹⁹ Division of Occupational Therapy and Physical Therapy, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
²⁰ Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
²¹ Department of Rehasport, Sport Medicine Lab, Department of Spine Disorders and Pediatric Orthopedics, University of Medical Sciences, Poznan, Poland.
²² Saint-Michel Campus, Institute of Physiotherapy of Saint-Etienne, Saint-Etienne, France.
²³ MS Knee Specialists, Bristol, UK.
²⁴ Division of Physical Therapy, Ohio State University, School of Health and Rehabilitation Sciences and OSU Sports Medicine Research Institute, Columbus, Ohio, USA.
²⁵ Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
²⁶ Medical Faculty, University Hospital of Iceland, Landspitali, University of Iceland, Reykjavik, Iceland.
²⁷ Department of Physical Therapy, University of Delaware, Newark, Delaware, USA.
²⁸ Department of Orthopedic and Trauma Surgery, Centre Hospitalier de Versailles, Le Chesnay-Rocquencourt, France.

PMID: 40501314
PMCID: PMC12310080
DOI: 10.1002/ksa.12689

Practice Guideline

The formal EU-US Meniscus Rehabilitation 2024 Consensus: An ESSKA-AOSSM-AASPT initiative. Part II-Prevention, non-operative treatment and return to sport

Robert Prill et al. Knee Surg Sports Traumatol Arthrosc. 2025 Aug.

. 2025 Aug;33(8):3014-3024.

doi: 10.1002/ksa.12689. Epub 2025 Jun 12.

Authors

Affiliations

¹ Department of Orthopedics and Traumatology, Brandenburg Medical School Theodor Fontane, University Hospital Brandenburg/Havel, Brandenburg an der Havel, Germany.
² Brandenburg Medical School Theodor Fontane, Faculty of Health Sciences Brandenburg, Brandenburg an der Havel, Germany.
³ Department of Orthopaedic Surgery, University of California, San Francisco, California, USA.
⁴ Centre Médical, ESSKA Office, Luxembourg.
⁵ Department of Orthopedics and Traumatology, Hospital del Mar, Barcelona, Spain.
⁶ Universitat Autònoma de Barcelona, Institut Català de Traumatologia i Medicina del'Esport (ICATME) - Hospital Universitari Dexeus, Knee and Arthroscopy Unit, Barcelona, Spain.
⁷ Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, USA.
⁸ Isokinetic Medical Group, FIFA Medical Centre of Excellence, Education & Research Department, Bologna, Italy.
⁹ Department of Orthopedic Surgery, VCU Health, Richmond, Virginia, USA.
¹⁰ Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania, USA.
¹¹ Cochrane Czech Republic, Czech CEBHC: JBI Centre of Excellence, Czech GRADE Network, Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic.
¹² Department of Orthopaedic Surgery, Michigan Medicine, Ann Arbor, Michigan, USA.
¹³ Physiotherapy Research Laboratory, University Centre of Physiotherapy and Rehabilitation, Faculty of Physiotherapy, Wroclaw Medical University, Wroclaw, Poland.
¹⁴ Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
¹⁵ Twin Cities Orthopedics, Edina and Eagan, Minnesota, USA.
¹⁶ Wichita State University, Ascension Via Christi, Wichita, Kansas, USA.
¹⁷ Sports & Orthopedics Research Center, Anna TopSupport, Eindhoven, The Netherlands.
¹⁸ Osteon Orthopedics and Sports Medicine Clinic, Mostar, Bosnia and Herzegovina.
¹⁹ Division of Occupational Therapy and Physical Therapy, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
²⁰ Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
²¹ Department of Rehasport, Sport Medicine Lab, Department of Spine Disorders and Pediatric Orthopedics, University of Medical Sciences, Poznan, Poland.
²² Saint-Michel Campus, Institute of Physiotherapy of Saint-Etienne, Saint-Etienne, France.
²³ MS Knee Specialists, Bristol, UK.
²⁴ Division of Physical Therapy, Ohio State University, School of Health and Rehabilitation Sciences and OSU Sports Medicine Research Institute, Columbus, Ohio, USA.
²⁵ Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
²⁶ Medical Faculty, University Hospital of Iceland, Landspitali, University of Iceland, Reykjavik, Iceland.
²⁷ Department of Physical Therapy, University of Delaware, Newark, Delaware, USA.
²⁸ Department of Orthopedic and Trauma Surgery, Centre Hospitalier de Versailles, Le Chesnay-Rocquencourt, France.

PMID: 40501314
PMCID: PMC12310080
DOI: 10.1002/ksa.12689

Abstract

Purpose: Part two of this consensus aimed to provide recommendations for the prevention of meniscus injuries, non-operative treatment of acute tears and degenerative lesions, return to sports and patient-reported outcome measures.

Methods: This consensus followed the European Society of Knee Surgery, Sports Traumatology and Arthroscopy (ESSKA) formal consensus methodology. For this combined ESSKA-American Orthopedic Society for Sports Medicine (AOSSM)-American Academy of Sports Physical Therapy (AASPT) initiative, 67 experts from 14 countries, including orthopedic surgeons and physiotherapists, were involved. The 26 Steering Group members established guiding questions, screened the existing evidence, and proposed statements, and provided Grades of recommendations. The 41 Rating Group members assessed the statements according to a Likert scale (1-9). Final documents were assessed by an international peer review group for geographical adaptability.

Results: Low to moderate scientific level of evidence was available, so that grades of recommendations were low (three Grade A ratings, four Grade B, three Grade C and 13 Grade D), underlining the relevance of this consensus. One strong and 17 relative agreements with overall median of 8 (8-9) and a mean of 7.92 ± 0.37 were achieved for 23 statements on 18 questions. Prevention of meniscus injuries is possible with general knee injury reduction programmes and through avoidance of certain activities. Non-operative treatment including physical therapy is the first line approach for degenerative meniscus lesions and may be an option for some acute tears. Return to sports after meniscus tear surgery should be both criterion-based and time-based. Patient reported outcomes in combination with performance-based measures are recommended to evaluate the rehabilitation process.

Conclusion: This international EU-US consensus established recommendations for prevention strategies, describes rehabilitation of non-operated patients and of patients after partial meniscectomy, meniscus repair and meniscus reconstruction, and establishes return to sport criteria. These updated and structured recommendations may be applied by surgeons and physiotherapists.

Level of evidence: Level I, consensus.

Keywords: knee; meniscectomy; non‐operative treatment; physical therapy; physiotherapy; repair.

© 2025 The Author(s). Co‐published by European Society of Sports Traumatology, Knee Surgery and Arthroscopy, American Orthopaedic Society for Sports Medicine, North American Sports Medicine Institute and Movement Science Media.

PubMed Disclaimer

Conflict of interest statement

Nicolas Pujol: occasional consultant for education for Smith & Nephew, Stryker, ZimmerBiomet. Philippe Beaufils: ESSKA Consensus Projects advisor. Stephanie Wong: Editor‐in‐Chief of Current Reviews in Musculoskeletal Medicine. Robert Prill: Chair of the ESSKA Rehabilitation Committee, Associate Editor KSSTA, occasional Consultant OPED GmbH. Airelle O. Giordano: Education Chair, AASPT. Robert F. LaPrade: Consultant: Smith and Nephew, Ossur; Royalties; Smith and Nephew, Ossur, Elsevier; Research support: AOSSM, AANA, Ossur, Smith and Nephew, Arthrex; Editorial Boards: AJSM, KSSTA, JEO, Journal of Knee Surgery; JISPT, OTSM; AOSSM: Nominating Committee; ISAKOS: Travelling Fellowship Committee, Programme Committee. Aaron J. Krych: Consulting and Royalties Arthrex, Inc. Editorial Boards: AJSM, KSSTA. AANA Board. James J. Irrgang: Currently serve as President of the Board of Directors of Movement Media Sciences/Journal of Orthopaedic & Sports Physical Therapy. Alexandre Rambaud: Member of ESSKA Rehabilitation Committee; Deputy Editor: European Rehabilitation Journal, Journal de Traumatologie du Sport, Editor‐in‐Chief of Kinésithérapie, la Revue. Laura C. Schmitt: Editorial Board: MSSE; Research Support from Arthritis Foundation and NFL Players Association. Jill K. Monson: Member AASPT Research Committee, Consultant Smith & Nephew. Mark V. Paterno: Co‐Chair AASPT Research Committee, Research Support from AOSSM/AIrCast Research Foundation. Simone Perelli: Paid consultancy for Smith & Nephew. Aleksandra Królikowska: Member of ESSKA Rehabilitation Committee. Nicky van Melick: Member of ESSKA Rehabilitation Committee. Jitka Klugarová: Deputy director of the Czech CEBHC: JBI Centre of Excellence, Czech GRADE Network, member of methodological group withing JBI and GRADE working group. The other authors did not declare any conflict of interest.

Figures

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References

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The formal EU-US Meniscus Rehabilitation 2024 Consensus: An ESSKA-AOSSM-AASPT initiative. Part II-Prevention, non-operative treatment and return to sport

Affiliations

The formal EU-US Meniscus Rehabilitation 2024 Consensus: An ESSKA-AOSSM-AASPT initiative. Part II-Prevention, non-operative treatment and return to sport

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