From meniscal resection to meniscal repair: a journey of the last decade
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EDITORIAL
From meniscal resection to meniscal repair: a journey of the last decade Roland Becker1 · Sebastian Kopf1 · Romain Seil2 · Michael T. Hirschmann3 · Philippe Beaufils4 · Jon Karlsson5
© The Author(s) 2020
The last decade has shed some light on the darkness sur‑ rounding the treatment of meniscal injuries. A significant amount of work has been done in order to provide a more scientific approach to the treatment of the injured meniscus. Degenerative meniscal lesions and traumatic meniscal tears differ in terms of aetiology and pathology and require differentiated diagnostic algorithms and treatments. A new terminology has; therefore, been defined by the ESSKA meniscus consensus project. A traumatic meniscal tear is * Roland Becker r.becker@klinikum‑brandenburg.de 1
Centre of Orthopaedics and Traumatology, Brandenburg Medical School Theodor Fontane, Hochstrasse 29, 14770 Brandenburg an der Havel, Germany
2
Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg-Clinique d’Eich, 76, rue d’Eich, 146 Luxembourg, Luxembourg
3
Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101 Bruderholz, Switzerland
4
Orthopaedic Department, Centre Hospitalier de Versailles, 177, rue de Versailles, 78157 Le Chesnay, France
5
Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
caused by an acute and sufficiently serious trauma to the knee. In contrast, a degenerative meniscal lesion occurs due to repetitive minor injuries and lacks a sufficiently serious single trauma. The second European Consensus has stud‑ ied the epidemiology, diagnosis and treatment of traumatic meniscal tears [14]. It follows the first consensus on the management of degenerative meniscal lesions, which was published in 2017 [3]. Both consensus reports combined basic science and knowledge of the clinical experience of more than 80 knee experts throughout Europe [3, 14, 23]. There are major differences in terms of the management of acute traumatic meniscal tears and degenerative meniscal lesions. While magnetic resonance imaging (MRI) should be performed early in traumatic tears for a satisfactory assess‑ ment of the pathology, there is no need for an immediate MRI when a degenerative meniscal lesion is suspected. An MRI will not only provide information about the location, type and size of the meniscal tear but also about the carti‑ lage and ligament integrity, which is important for correct surgical planning. Complete meniscal resection was the primary treat‑ ment option for any type of meniscal tear in the past. The orthopaedic mindset has changed markedly over the last decade. The importance of the meniscus in terms of shock absorption, knee stability, load distribution, lubrication, proprioception and neuromuscular function has been well
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recognised over the years [1, 4, 17]. Based on these findings, there is general agreement about preserving the meniscus when
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