An Open Letter to the Editor of The BMJ

Arthroscopy Honors 2023 Award Winning Publications and Authors

With earnest appreciation to the Arthroscopy Association of North America Education Foundation for its generous support for Arthroscopy's Annual Awards, we announce the 2023 publications determined to represent the best clinical research, basic science research, resident/fellow research, and systematic reviews published in 2023, as well as the most downloaded and most cited articles published 5 years ago. This year, we also present the inaugural award for the Most Viewed Arthroscopy Techniques article and video published 5 years ago, as well as our best Podcasts of 2023.

Association Between Baseline "Meniscal symptoms" and Outcomes of Operative and Non-Operative Treatment of Meniscal Tear in Patients with Osteoarthritis

OBJECTIVE

Patients with meniscal tears reporting "meniscal symptoms" such as catching or locking, have traditionally undergone arthroscopy. We investigated whether patients with meniscal tears who report "meniscal symptoms" have greater improvement with arthroscopic partial meniscectomy (APM) than physical therapy (PT).

METHODS

We used data from the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial, which randomized participants with knee osteoarthritis (OA) and meniscal tear to APM or PT. The frequency of each "meniscal symptom" (clicking, catching, popping, intermittent locking, giving way, swelling) was measured at baseline and 6-months. We used linear regression models to determine whether the difference in improvement in KOOS Pain at 6-months between those treated with APM versus PT was modified by the presence of each "meniscal symptom". We also determined the percent of participants with resolution of "meniscal symptoms" by treatment group.

RESULTS

We included 287 participants. The presence (vs. absence) of any of the "meniscal symptoms" did not modify the improvement in KOOS Pain between APM vs. PT by more than 0.5 SD (all p-interaction >0.05). APM led to greater resolution of intermittent locking and clicking than PT (locking 70% vs 46%, clicking 41% vs 25%). No difference in resolution of the other "meniscal symptoms" was observed.

CONCLUSION

"Meniscal symptoms" were not associated with improved pain relief. Although symptoms of clicking and intermittent locking had a greater reduction in the APM group, the presence of "meniscal symptoms" in isolation should not inform clinical decisions surrounding APM vs. PT in patients with meniscal tear and knee OA.

Degenerative Meniscus Lesions: An Expert Consensus Statement Using the Modified Delphi Technique

PURPOSE

The purpose of this study was to perform an evidence-based, expert consensus survey using the Delphi panel methodology to develop recommendations for the treatment of degenerative meniscus tears.

METHODS

Twenty panel members were asked to respond to 10 open-ended questions in rounds 1 and 2. The results of the first 2 rounds served to develop a Likert-style questionnaire for round 3. In round 4, the panel members outside consensus were contacted and asked to either change their score in view of the group's response or argue their case. The level of agreement for round 4 was defined as 80%.

RESULTS

There was 100% agreement on the following items: insidious onset, physiological part of aging, tears often multiplanar, not all tears cause symptoms, outcomes depend on degree of osteoarthritis, obesity is a predictor of poor outcome, and younger patients (<50 years) have better outcomes. There was between 90% and 100% agreement on the following items: tears are nontraumatic, radiographs should be weightbearing, initial treatment should be conservative, platelet-rich plasma is not a good option, repairable and peripheral tears should be repaired, microfracture is not a good option for chondral defects, the majority of patients obtain significant improvement and decrease in pain with surgery but results are variable, short-term symptoms have better outcomes, and malalignment and root tears have poor outcomes.

CONCLUSIONS

This consensus statement agreed that degenerative meniscus tears are a normal part of aging. Not all tears cause symptoms and, when symptomatic, they should initially be treated nonoperatively. Repairable tears should be repaired. The outcome of arthroscopic partial meniscectomy depends on the degree of osteoarthritis, the character of the meniscus lesion, the degree of loss of joint space, the amount of malalignment, and obesity. The majority of patients had significant improvement, but younger patients and patients with short-term symptoms have better outcomes.

LEVEL OF EVIDENCE

Level V - expert opinion.