New guideline establishes guidance based on
latest in evidence-based recommendations
ROSEMONT, Ill., July 1, 2024
/PRNewswire/ -- The American Academy of Orthopaedic Surgeons (AAOS)
issued a new Clinical Practice Guideline (CPG) for the Management
of Acute Isolated Meniscal Pathology, which was created to help the
orthopaedic community treat patients suspected of or diagnosed with
an acute isolated meniscal tear.
To view the full guideline, click here.
About the Condition
Acute isolated meniscal tears
often occur from a traumatic injury with rotation and flexion of
the knee or direct impact. While it can happen to anyone, many
acute isolated meniscal tears occur in a young active population,
specifically high school and college athletes. Meniscal injuries
can have a significant physical and emotional impact as patients
need to take time off from work or school. For athletes, return to
sport may take up to 4-7 months post-surgery.
"Treating acute meniscal tears is still an evolving area and
compared to other guidelines that detail recommendations for the
treatment of various musculoskeletal issues, the body of evidence
surrounding this injury is relatively lacking," said Robert Brophy, MD, FAAOS, co-chair of the
guideline development group. "While acute meniscal tears are
common, there is more heterogeneity in terms of the injury, the
pattern associated with the injury, and treatments, making it a
more difficult area to study. This new CPG is a first step towards
establishing guidelines and laying the foundation for developing a
higher level of evidence to inform future recommendations."
New Diagnosis and Treatment Recommendations
The new
guideline resulted in one strong and two moderate recommendations
pertaining to the diagnosis and management of patients with acute
meniscal injury. The CPG is not intended for patients with
concurrent ligament issues like anterior cruciate ligament tears,
nor is it appropriate for those suspected of chronic or
degenerative meniscal tears. The CPG includes:
- A strong recommendation stating that magnetic resonance imaging
(MRI) is the preferred imaging modality to diagnose acute meniscal
tears because of its high accuracy, while computerized tomography
(CT) arthrography or ultrasound can be used, particularly when MRI
is not available or is contraindicated.
- A moderate recommendation that a physical examination,
including joint line tenderness, the McMurray test and the Thessaly
test, can effectively diagnose acute meniscal tears and may yield
more accurate results when combined.
- A moderate recommendation that when indicated in the treatment
of acute meniscal tear, surgery should preserve as much functional
meniscal tissue as possible to mitigate patient risk for
osteoarthritis, underscoring the importance of trying to preserve
the meniscus to delay or prevent advancement of joint
degeneration.
The CPG workgroup formulated six options for physicians and
patients to consider. Options are used when there is little,
conflicting or no evidence. Highlights of the options include:
- A limited strength option states that patients with an acute
meniscal tear who have failed conservative nonoperative treatment
such as physical therapy may have better outcomes from surgical
intervention within six months of injury.
- It is the consensus of the workgroup that patients with a
displaced or displacing acute meniscal tear, particularly those
restricting knee range of motion, can benefit from acute surgical
intervention. The workgroup also advises that patients with a
symptomatic acute meniscal tear who could benefit from a repair
should be considered for early surgical intervention as it could
optimize the likelihood for success.
- A limited strength option states that meniscus repair can
improve patient outcomes compared to partial meniscectomy in acute
isolated meniscal tears with healing potential.
- Biological enhancements, specifically bone marrow venting or
platelet-rich plasma, received a limited strength option as a
consideration to improve outcomes in patients undergoing surgical
repair of acute isolated meniscal tears.
- Based on the workgroup's clinical opinion, physical
therapy/rehabilitation may be beneficial to patients who present
with an acute non-displaced isolated meniscal tear not amenable to
repair when implemented as a non-operative treatment option as well
as for those recovering from meniscal surgery.
"There's no doubt physical therapy is an integral part of the
treatment algorithm for people with acute meniscal tears," said Dr.
Brophy. "Whether you're trying to avoid surgery, planning on not
doing surgery, or decide to do surgery, there will likely be a role
for physical therapy as part of the treatment or recovery
process."
While the study of acute meniscal tears is complex, physicians
and patients now have a starting point to weigh the pros and cons
to make informed decisions.
"It is important to understand that this CPG is a guide, not a
prescription," said Dr. Brophy. "However, this can help patients
make an informed decision with their surgeon regarding optimal
treatment for their injury."
Intended CPG Use
CPGs are not meant to be stand-alone
documents but rather serve as a point of reference and educational
tool for orthopaedic surgeons and healthcare professionals managing
patients presenting with complaints that may be attributable to
acute isolated meniscal tears. CPGs recommend accepted approaches
to treatment and/or diagnosis and are not intended to be a fixed
protocol for treatment or diagnosis. Patient care and treatment
should always be based on a clinician's independent medical
judgment and the individual patient's specific clinical
circumstances. The guideline is not intended for use as a benefits
determination document.
The full Clinical Practice Guideline for the Management of Acute
Isolated Meniscal Pathology is intended for reference by
orthopaedic surgeons and other physicians, and is available through
AAOS' OrthoGuidelines website and free mobile
app. For more information on the development process for AAOS
clinical practice guidelines, please view the Clinical
Practice Guideline Methodology.
Development of this CPG was a collaborative effort between
representatives from the American Academy of the Physical Medicine
and Rehabilitation; the National Athletic Trainers' Association;
the American Orthopaedic Society for Sports Medicine, the American
Physical Therapy Association; the Pediatric Orthopaedic Society of
North America; and the American
Medical Society for Sports Medicine.
About the AAOS
With more than 39,000 members,
the American Academy of Orthopaedic Surgeons is the world's
largest medical association of musculoskeletal specialists. The
AAOS is the trusted leader in advancing musculoskeletal health. It
provides the highest quality, most comprehensive education to help
orthopaedic surgeons and allied health professionals at every
career level to best treat patients in their daily practices. The
AAOS is the source for information on bone and joint conditions,
treatments and related musculoskeletal healthcare issues; and it
leads the healthcare discussion on advancing quality.
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SOURCE American Academy of Orthopaedic Surgeons