Treatment of Meniscal Tear: The More We Learn, the Less We Know
Authors: Jeffrey N. Katz, Morgan H. Jones
Journal: Annals of Internal Medicine (2016)

Editorials5 April 2016Treatment of Meniscal Tear: The More We Learn, the Less We KnowJeffrey N. Katz, MD, MSc and Morgan H. Jones, MD, MPHJeffrey N. Katz, MD, MScFrom Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, and Cleveland Clinic, Cleveland, Ohio. and Morgan H. Jones, MD, MPHFrom Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, and Cleveland Clinic, Cleveland, Ohio.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M16-0049 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Symptomatic knee osteoarthritis (OA) affects more than 10 million persons in the United States and many more worldwide. Because therapies that arrest progression of knee OA are lacking, when clinicians see middle-aged and older patients with knee pain, they often seek alternative or additional diagnoses that are more amenable to treatment. Clinicians are particularly eager to identify symptomatic meniscal tear in this setting because of the belief that arthroscopic partial meniscectomy (APM) treats the tear effectively. Therefore, generations of clinicians have been trained to elicit a history of symptoms that are believed to suggest a symptomatic meniscal tear, such as ...References1. Englund M, Guermazi A, Gale D, Hunter DJ, Aliabadi P, Clancy M, et al. Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med. 2008;359:1108-15. [PMID: 18784100] doi:10.1056/NEJMoa0800777 CrossrefMedlineGoogle Scholar2. Sihvonen R, Englund M, Turkiewicz A, Järvinen TLN; Finnish Degenerative Meniscal Lesion Study Group. Mechanical symptoms and arthroscopic partial meniscectomy in patients with degenerative meniscus tear. A secondary analysis of a randomized trial. Ann Intern Med. 2016;164:449-55. doi:10.7326/M15-0899 LinkGoogle Scholar3. Sihvonen R, Paavola M, Malmivaara A, Itälä A, Joukainen A, Nurmi H, et al; Finnish Degenerative Meniscal Lesion Study (FIDELITY) Group. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med. 2013;369:2515-24. [PMID: 24369076] doi:10.1056/NEJMoa1305189 CrossrefMedlineGoogle Scholar4. Englund M, Roos EM, Roos HP, Lohmander LS. Patient-relevant outcomes fourteen years after meniscectomy: influence of type of meniscal tear and size of resection. Rheumatology (Oxford). 2001;40:631-9. [PMID: 11426019] CrossrefMedlineGoogle Scholar5. Katz JN, Brophy RH, Chaisson CE, de Chaves L, Cole BJ, Dahm DL, et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med. 2013;368:1675-84. [PMID: 23506518] doi:10.1056/NEJMoa1301408 CrossrefMedlineGoogle Scholar6. Herrlin SV, Wange PO, Lapidus G, Hållander M, Werner S, Weidenhielm L. Is arthroscopic surgery beneficial in treating non-traumatic, degenerative medial meniscal tears? A five year follow-up. Knee Surg Sports Traumatol Arthrosc. 2013;21:358-64. [PMID: 22437659] doi:10.1007/s00167-012-1960-3 CrossrefMedlineGoogle Scholar7. Yim JH, Seon JK, Song EK, Choi JI, Kim MC, Lee KB, et al. A comparative study of meniscectomy and nonoperative treatment for degenerative horizontal tears of the medial meniscus. Am J Sports Med. 2013;41:1565-70. [PMID: 23703915] doi:10.1177/0363546513488518 CrossrefMedlineGoogle Scholar8. Gauffin H, Tagesson S, Meunier A, Magnusson H, Kvist J. Knee arthroscopic surgery is beneficial to middle-aged patients with meniscal symptoms: a prospective, randomised, single-blinded study. Osteoarthritis Cartilage. 2014;22:1808-16. [PMID: 25086401] doi:10.1016/j.joca.2014.07.017 CrossrefMedlineGoogle Scholar9. Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. 1994;331:69-73. [PMID: 8208267] CrossrefMedlineGoogle Scholar10. Girish G, Lobo LG, Jacobson JA, Morag Y, Miller B, Jamadar DA. Ultrasound of the shoulder: asymptomatic findings in men. AJR Am J Roentgenol. 2011;197:W713-9. [PMID: 21940544] doi:10.2214/AJR.11.6971 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, and Cleveland Clinic, Cleveland, Ohio.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-0049.Corresponding Author: Jeffrey N. Katz, MD, MSc, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115; e-mail, [email protected]org.Current Author Addresses: Dr. Katz: Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.Dr. Jones: Department of Orthopedic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland OH 44106.This article was published at www.annals.org on 9 February 2016. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoMechanical Symptoms and Arthroscopic Partial Meniscectomy in Patients With Degenerative Meniscus Tear Raine Sihvonen , Martin Englund , Aleksandra Turkiewicz , Teppo L.N. Järvinen , and Treatment of Meniscal Tear Rachelle Buchbinder and Ian Harris Treatment of Meniscal Tear Jeffrey N. Katz and Morgan H. Jones Metrics Cited byThe Conversion Rate of Arthroscopy to Total Joint Arthroplasty in Patients with Knee OsteoarthritisArthroscopy for Knee Osteoarthritis in the XXI Century: a Systematic Review of Current High Quality Researches and Guidelines of Professional SocietiesTrends in knee arthroscopy utilization: a gap in knowledge translationArthroscopic meniscal surgeryAdverse outcomes after arthroscopic partial meniscectomy: a study of 700 000 procedures in the national Hospital Episode Statistics database for EnglandNational consensus on the definition, investigation, and classification of meniscal lesions of the kneeArthroscopic partial meniscectomy versus placebo surgery for a degenerative meniscus tear: a 2-year follow-up of the randomised controlled trialThe likelihood of total knee arthroplasty following arthroscopic surgery for osteoarthritis: a systematic reviewTreatment of Meniscal TearRachelle Buchbinder, MBBS(Hons), MSc, PhD and Ian Harris, AM, MBBS, MMed(Clin Epi), PhDA Web-Based Platform for Patients With Osteoarthritis of the Hip and Knee: A Pilot Study 5 April 2016Volume 164, Issue 7Page: 503-504KeywordsArthroscopyDisclosureIntent to treat analysisKneesLesionsOrthopedicsOsteoarthritisPhysiotherapySurgeonsSurgery ePublished: 9 February 2016 Issue Published: 5 April 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. 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