Practice Practice Pointer

Management of degenerative meniscal tears and the role of surgery

BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h2212 (Published 04 June 2015) Cite this as: BMJ 2015;350:h2212
  1. Rachelle Buchbinder, director, professor of clinical epidemiology12,
  2. Ian A Harris, professor of orthopaedic surgery3,
  3. Andrew Sprowson, associate professor of trauma and orthopaedics4
  1. 1Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, VIC 3144, Australia
  2. 2Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, Melbourne, Vic, Australia
  3. 3Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Liverpool, NSW, Australia
  4. 4Warwick Clinical Trials Unit, Warwick University, Coventry, UK
  1. Correspondence to: R Buchbinder rachelle.buchbinder{at}monash.edu

The bottom line

  • Degenerative meniscal tears are common and correlate poorly with symptoms; no clinical features are diagnostic

  • Avoid routine magnetic resonance imaging in primary care unless the patient has a locked knee (sudden inability to fully extend) or serious disease is suspected

  • First line treatment comprises non-operative modalities, such as education, self management, exercise, weight loss if overweight or obese, walking aids if indicated, paracetamol, non-steroidal anti-inflammatory drugs, and intra-articular glucocorticoids. Current evidence does not support a role for arthroscopic debridement, washout, or partial meniscectomy

How patients were involved in the creation of this article

Eight patients (four each from the UK and Australia) read the manuscript and provided comments. They made some suggestions for improving clarity in the advice for patients box, which we have incorporated.

The use of knee arthroscopy to treat degenerative meniscal tears is well established worldwide. However, with the advent of high quality randomised controlled trials questioning its value, observations that these lesions are usually asymptomatic, and recognition that arthroscopy is a “difficult habit to break,”1 it is timely to review the best evidence based management of these tears and reconsider the role of surgery.

Classification of meniscal tears

The menisci are two largely aneural crescent shaped discs of fibrocartilage, which sit within the lateral and medial compartments of the knee joint. They evenly transfer load across the joint, absorb shock during dynamic movement, and lubricate and help stabilise the joint. Injury, degeneration, or surgical removal of all or part of the meniscus is associated with an increased risk of developing knee osteoarthritis.2 The risk of osteoarthritis and its progression increase in line with reductions in tibial cartilage coverage.

Meniscal tears are categorised as traumatic or non-traumatic (degenerative) on the basis of their presentation. Traumatic tears tend to occur in younger active people (<40 years) and are caused by a serious traumatic injury, often while playing sport. Degenerative tears …

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