Management of degenerative meniscal tears and the role of surgery

#### The bottom line #### 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. 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 …