You mentioned “Arthroscopic partial meniscectomy is one of the most popular orthopaedic procedures, but recent publications stated that non-operative treatments have similar results to arthroscopic surgery.”

I agree with those statements. Moreover, “Arthroscopic partial meniscectomy may increase the risk of osteoarthritis.”

My approach for degenerative meniscus lesions is in two ways:

1. If there is no degenerative meniscus flap which has the potential to be a loose body and to cause irritation in the knee joint, I prefer non-surgical treatment. This includes neuromuscular rehabilitation.

2. If there is degenerative meniscus flap which has the potential to be a loose body and to cause irritation in the knee joint, I prefer surgical treatment. This includes arthroscopic partial meniscectomy plus neuromuscular rehabilitation.

Best wishes.

O. Sahap Atik, MD

Professor in Orthopedic Surgery, President of Turkish Joint Diseases Foundation, Editor-in-Chief of the journal of Joint Diseases and Related Surgery (indexed in PubMed as Eklem Hastalik Cerrahisi)

Fantastic dear Sahap. Thank you very much for sharing with us your approach. In fact, according to the study of Englund et al. Arthritis Rheum. 2003, "an isolated meniscal tear treated by limited meniscectomy is associated with a high risk of radiographic and symptomatic tibiofemoral OA at 16-year followup" with a RR of 2.7 for a Traumatic type of tear VS 7.0 for the Degenerative tear. Numbers are very surprising!!!😳

Can you please share with us your tips to determine that a tear is unstable and be a potential loose body and irritate or block the knee?

Regards.

it is better to choise some artroscopic method but not to make resection, like intraarticular laser terapy, and in next 10 days to make LLLT with skin contact, if the lesion is superficial.

I fully agree with Sahap Atik’s approach. Best regards

Thank you dear Elizabeta for your reply. Can you please explain with more detail to people (like me) that are not familiarized with intra-articular laser therapy and how do you approach DML? How do you guide the needle into the site of the lesion? Do you have good results? Regards

I also agree with the approach of professor Still approach

Sorry professor Atik's approach. I mean

I have found arthroscopic partial meniscectomy in the degenerative knee is most effective when a flap tear of the medial meniscus is displaced and tenting under the MCL. Patients are counseled that the localized pain from the impingement will be improved, but the diffuse degenerative knee pain will be relatively unchanged from the surgery.

If there is degenerative meniscus flap, I resect only the Flap, and leave the rest of the meniscus.

Mechanical symptoms = arthroscopic menisectomy. Otherwise, treat as osteoarthritis.

My initial approach with DML is non operative with focus on rehabilitation. if no improvement with non operative approach, I offer arthroscopy that gives me an opportunity to look at the joint surfaces and perform limited debridement of the lesion preserving as much as meniscus as possible.

My indication of an urgent arthroscopy is a locked knee due to DML. Fortunately it is that common but seen occasionally in my practice.

Apology for typing error

In the last sentence meant " Fortunately it is not that common and seen occasionally in my practice".

Dear Gustavo, thank you for your important question ( it was "Can you please share with us your tips to determine that a tear is unstable and be a potential loose body and irritate or block the knee?"). The answer is not so easy and clear . However my approach is as follows;

1. To see the flap on MR.

2. Increased pain during physical examination of the knee joint.

Best regards.

Hello,

my aproach to degenerative meniscus lesion depends on the simptoms , the hystory how it started and the time since first simptons began. Also MRI help a lot.

If there is a flap on MRI and there is history of acute onset after a fall or trauma I would go ahead a scope the patient and resect as little possible from the meniscus with shaver and compactification with electrocautery of the rest of the meniscus.

Most of the time degenerative meniscus tear are associated with patello femoral chondropathy or other compartments of the knee

So i advise the patient that after the knee scope he/she may need Hyaluronic acid injection or corticose injection and physical therapy

Thank you dear Edvin. Do you have personal experience/belief that the risk of a symptomatic OA after a meniscus tear and arthroscopic partial meniscectomy is higher in a degenerative meniscus tear compared to a traumatic tear (as shown by Englund et al. Arthritis Rheum 2003)?

Why do you think that lateral meniscectomy is worse in terms of future OA? (Due to its mobility, joint surface...?)

If no degenerative flap or floating loose bodies or mechanical symptoms so rehab. However if any of these present then partial meniscectomy is an option.

I prefer to treat initially these lesions with conservatives approaches, but if theses treatment fail, or we have flaps or loose bodies i can perform the arthroscopy counseling the patients regarding the risks of osteoarthritis progression including pain worsening.

best regards

In my experience, most of the degenerative ruptures of the meniscus can be treated conservatively. Protocol in conservative treatment is CS injection if need (with a painful and inflamed knee), a week later injection of hyaluronic acid or PRP and immediately after the injections series of PST treatments (a series of 9 treatments in a daily sequence) with more than 70% good and excellent results in my practice.

If there is no improvement, my recommendation is arthroscopic treatment by new "SuperBall" meniscal repair system (Arcuro medical).