CONSENSUS RECOMMENDATION One low quality study (Marder, 1994) was included, comparing surgical treatment of meniscal tears with nonoperative treatment. There is a paucity of research comparing outcomes from operative and nonoperative treatment of isolated acute meniscal tears. Patients with an isolated meniscal tear that suddenly limits active knee movement, either intermittently or constantly, may benefit from early surgical intervention. Patients active with sports that require loading, pivoting, and/or landing may benefit from early surgical treatment of an acute isolated meniscal injury. The viability to repair torn meniscal tissue may be diminished when surgical intervention is delayed. Nondisplaced tears unlikely to be repairable should be treated initially with physical therapy and undergo surgical management if symptoms persist. Additional future research is needed to compare the short and long-term functional outcomes and return to activity in patients undergoing operative and non-operative treatment of acute isolated meniscal injuries. There is a preponderance of literature of meniscal tears with concomitant injuries. The biological milieu of the knee and following cruciate ligament injuries varies from those with an isolated meniscal injury; therefore, future research is needed in isolated meniscal tears.
Benefits/Harms of Implementation
There is general risk when patients undergo surgery and anesthesia for orthopedic conditions, which may include, but are not limited to death, neurovascular injury, infection, thromboembolic events, and postoperative sequelae such as joint stiffness or degeneration. Nondisplaced tears unlikely to be repairable have little downside if delayed surgical treatment is necessary after initial nonoperative management. However, in the case of displaced meniscal tears blocking knee motion or meniscal tears likely to be repairable, there are potential downsides of delaying surgical intervention.
Outcome Importance
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. Since MRI evaluation is less accurate than direct arthroscopic visualization to determine meniscal tear type, location and tissue viability, which guide the decision to repair or resect, treatment plans may change during surgery and modify postoperative rehabilitation and recovery.
Cost Effectiveness/Resource Utilization
Non-operative management with skilled physical therapy or directed rehabilitation at home can be an effective treatment for acute non-displaced meniscus tears. However, patients who fail conservative management may still require surgical intervention, which delays but does not decrease medical cost. Insufficient rehabilitation or delay in surgical management when indicated can delay recovery and return to work and increase the risk of less optimal outcomes.
Acceptability
Patients returning to pivoting or landing activities may benefit from early surgical intervention for a quicker return to play or work, even in the absence of limited knee motion. Even patients without “symptomatic” knees, as defined above, who receive salaries from athletics could benefit from surgical intervention for a quicker and more reliable return to play. However, the short-term benefit of quicker recovery after resection compared to repair has to be weighed against the risk of more rapid joint degeneration over time, which can reduce performance and durability.
Feasibility
No obvious barriers to identify.
Future Research
Topics to be addressed with future research include:
Which meniscal tear, i.e., location, type and length of tear, would normally need and therefore benefit from surgery vs initial nonoperative management?
How long should high-level verses lower-level athletes trial nonoperative treatment before undergoing surgical intervention?
How do variables such as age, body mass index, and type and level of activity influence optimal treatment and outcomes from acute isolated meniscal tears?
Additional References
1. Cook C.E. et al. (2021). Does Surgery for Cruciate Ligament and Meniscus Injury Increase the Risk of Comorbidities at 2 Years in the Military System? The Journal of Knee Surgery.
2. van der Graaff SJA, Eijgenraam SM, Meuffels DE et al. (2022). Arthroscopic partial meniscectomy versus physical therapy for traumatic meniscal tears in a young study population: a randomised controlled trial. Br J Sports Med(56), 870-876.