SURGICAL INTERVENTION AFTER NON-OPERATIVE TREATMENT

Two low quality studies (Marder, 1994; Stone, 1988) evaluated the timing of surgical intervention in the management of acute meniscal tears. Appreciating the historical nature of the cited articles, these studies clearly demonstrated a significantly greater ability for patients to return to their prior athletic level with intermittent to no pain when surgical intervention was performed prior to 6 months. An increased percentage of patients had persistent pain or inability to return to prior activity when surgical intervention was performed after 6 months. Additionally, younger patients without radiographic evidence of osteoarthritis have an increased likelihood of resolution of pain and return to athletics following surgical intervention when performed prior to 6 months from onset. For patients who are returning to a level of activity that does not involve increased load such as jumping, landing, and/or pivoting, non-operative initial management is recommended. However, when initial non-surgical management fails to improve symptoms and function adequately, surgical intervention should be performed prior to 6 months.

Benefits/Harms of Implementation
In addition to the general risks for anesthesia and surgical intervention, the ability to comply with activity limitations and duration of rehabilitation following surgical intervention should be considered when determining if operative or non-operative treatment is pursued. Emphasis should also be placed on patient education in order to facilitate rehabilitation compliance. Delayed surgical treatment of acute symptomatic meniscal injury beyond six months has decreased function, increased pain, and increased chondromalacia and post traumatic arthritis.

Outcome Importance
Addressing meniscal pathology in a timely fashion may result in improved outcomes.

Cost Effectiveness/Resource Utilization
There is no association with cost effectiveness.

Acceptability
Meniscus surgery is an acceptable treatment for acute isolated symptomatic meniscal injury and may be warranted without a trial of non-operative treatment in some circumstances.

Feasibility
Surgical treatment of acute meniscal pathology is feasible and performed regularly within 6 months of injury.

Future Research
High quality studies to prospectively follow acute meniscal injuries are required to determine if and when early operative intervention is indicated.