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Management of traumatic meniscus tears: the 2019 ESSKA meniscus consensus

Abstract
Purpose The importance of meniscus integrity in the prevention of early osteoarthritis is well known, and preservation is accepted as the primary goal. The purpose of the ESSKA (European Society for Sports Traumatology, Knee Surgery and Arthroscopy) European consensus on traumatic meniscus tears was to provide recommendations for the treatment of meniscus tears based on both scientifc evidence and the clinical experience of knee experts.
Methods Three groups of surgeons and scientists elaborated and ratifed the so-called formal consensus process to defne the recommendations for the management of traumatic meniscus tears. A traumatic meniscus tear was defned as a tear with an acute onset of symptoms caused by a sufcient trauma. The expert groups included a steering group of eight European surgeons and scientists, a rating group of another nineteen European surgeons, and a peer review group. The steering group prepared twenty-seven question and answer sets based on the scientifc literature. The quality of the answers received grades of A (a high level of scientifc support), B (scientifc presumption), C (a low level of scientifc support) or D (expert opinion). These question and answer sets were then submitted to and evaluated by the rating group. All answers were scored from 1 (=totally inappropriate) to 9 (=totally appropriate) points. Thereafter, the comments of the members of the rating group were incorporated by the steering group and the consensus was submitted to the rating group a second time. Once a general consensus was reached between the steering and rating groups, the fnalized question and answer sets were submitted for fnal review by the peer review group composed of representatives of the ESSKA-afliated national societies. Eighteen representatives replied.

Results The review of the literature revealed a rather low scientifc quality of studies examining the treatment of traumatic meniscus tears. Of the 27 questions, only one question received a grade of A (a high level of scientifc support), and another received a grade of B (scientifc presumption). The remaining questions received grades of C and D. The mean rating of all questions by the rating group was 8.2 (95% confdence interval 8.1–8.4). A general agreement that MRI should be performed on a systematic basis was not achieved. However, MRI was recommended when arthroscopy would be considered
to identify concomitant pathologies. In this case, the indication for MRI should be determined by a musculoskeletal specialist. Based on our data, stable left in situ lateral meniscus tears appear to show a better prognosis than medial tears. When repair is required, surgery should be performed as early as possible. Evidence that biological enhancement such as needling or the application of platelet-rich plasma would improve healing was not identifed. Preservation of the meniscus should be considered as the frst line of treatment because of an inferior clinical and radiological long-term outcome after partial meniscectomy compared to meniscus repair.

Discussion The consensus was generated to present the best possible recommendations for the treatment of traumatic meniscus tears and provides some groundwork for a clinical decision-making process regarding the treatment of meniscus tears. Preservation of the meniscus should be the frst line of treatment when possible, because the clinical and radiological long-term outcomes are worse after partial meniscectomy than after meniscus preservation. The consensus clearly states that numerous meniscus tears that were considered irreparable should be repaired, e.g., older tears, tears in obese patients, long tears, etc.

Level of evidence II

Authors

Sebastian Kopf1 · Philippe Beaufls2, Michael T.Hirschmann, Niccolò Rotigliano, Matthieu Ollivier, Helder Pereira, Rene Verdonk, Nikica DarabosPanagiotis Ntagiopoulos, David Dejour, Romain Seil10,11 · Roland Becker12
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