Trends in Meniscus Repair and Meniscectomy in the US

Physicians are changing how they manage meniscal tears, according to a recent study that reviewed treatment methods over a seven year period.  Often when new evidence shows a better way to treat a problem it takes years for surgeons to alter their practice methods.  This study concluded that surgeons have changed their treatment to reflect the most up to date practice. The authors attribute the change in treatment to new evidence and changes in physician education regarding effective treatment. This is good news for the prevention of knee arthritis.

The meniscus is a c-shaped piece of cartilage that is found on both sides of the knee joint sandwiched between the ends of your bones.  It serves as a barrier between the leg bones, helps to redistribute twisting forces and decreases the wear and tear on the underlying cartilage covering the end of the bones.

The meniscus may be torn either by degeneration or by acute trauma.  Sometimes when an individual sustains  a blow to the knee both the meniscus and  the anterior cruciate ligament (ACL) tear.  A tear typically causes knee locking and catching, swelling, and pain.  In the past, the standard treatment for a torn meniscus was removal, or meniscectomy.  However, because recent studies have shown 60 per cent of menisectomies result in osteoarthritis (or the wearing away of the cartilage covering the end of the bones), physician education has changed to emphasize preserving the meniscus.  The attempt to preserve the meniscus is called a meniscus repair and involves suturing the structure back together as best possible.  

Review of over two billion patient records from 2005-2011 showed an increase of 11.4 per cent in the number of meniscal repairs, with young males and patients under 25 years old having the greatest increase in meniscal repair surgeries. Additionally, there was a 48.3 per cent increase in ACL reconstruction in conjunction with meniscus repairs. This data suggests that physicians are changing their method of treatment of meniscus tears to reflect their training and are repairing meniscus when able instead of simply removing the tissue.

Reference: Geoffrey D. Abrams, MD, et al. Trends in Meniscus Repair and Meniscectomy in the United States, 2005-2011. In American Journal of Sports Medicine. July 17, 2013. Vol. 41, No. 10. Pp. 2333-2339.

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