title: Surgical management of degenerative meniscus lesions: the 2016 ESSKA meniscus consensus.
abstract: OBJECTIVE
  A degenerative meniscus lesion is a slowly developing process typically involving a horizontal cleavage in a middle-aged or older person. When the knee is symptomatic, arthroscopic partial meniscectomy has been practised for a long time with many case series reporting improved patient outcomes. Since 2002, several randomised clinical trials demonstrated no additional benefit of arthroscopic partial meniscectomy compared to non-operative treatment, sham surgery or sham arthroscopic partial meniscectomy. These results introduced controversy in the medical community and made clinical decision-making challenging in the daily clinical practice. To facilitate the clinical decision-making process, a consensus was developed. This initiative was endorsed by ESSKA.
  
  
  METHODS
  A degenerative meniscus lesion was defined as a lesion occurring without any history of significant acute trauma in a patient older than 35 years. Congenital lesions, traumatic meniscus tears and degenerative lesions occurring in young patients, especially in athletes, were excluded. The project followed the so-called formal consensus process, involving a steering group, a rating group and a peer-review group. A total of 84 surgeons and scientists from 22 European countries were included in the process. Twenty questions, their associated answers and an algorithm based on extensive literature review and clinical expertise, were proposed. Each question and answer set was graded according to the scientific level of the corresponding literature.
  
  
  RESULTS
  The main finding was that arthroscopic partial meniscectomy should not be proposed as a first line of treatment for degenerative meniscus lesions. Arthroscopic partial meniscectomy should only be considered after a proper standardised clinical and radiological evaluation and when the response to non-operative management has not been satisfactory. Magnetic resonance imaging of the knee is typically not indicated in the first-line work-up, but knee radiography should be used as an imaging tool to support a diagnosis of osteoarthritis or to detect certain rare pathologies, such as tumours or fractures of the knee.
  
  
  CONCLUSIONS
  The present work offers a clear framework for the management of degenerative meniscus lesions, with the aim to balance information extracted from the scientific evidence and clinical expertise. Because of biases and weaknesses of the current literature and lack of definition of important criteria such as mechanical symptoms, it cannot be considered as an exact treatment algorithm. It summarises the results of the "ESSKA Meniscus Consensus Project" ( http://www.esska.org/education/projects ) and is the first official European consensus on this topic. The consensus may be updated and refined as more high-quality evidence emerges.
  
  
  METHODS
  I.
authors.affiliation: Orthopaedics Department, Centre Hospitalier de Versailles, 78150, Le Chesnay, France.
authors.forename: Ph
authors.initials: P
authors.lastname: Beaufils
authors.affiliation: Department of Orthopaedics and Traumatology, Hospital Brandenburg, Medical School Theodor Fontane, Hochstrasse 26, 14770, Brandenburg, Havel, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Becker
authors.affiliation: Center for Musculosketal Surgery, Charité - University Medicine Berlin, AugustenburgerPlatz 1, 13353, Berlin, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Kopf
authors.affiliation: Orthopaedics, Clinical Epidemiology Unit, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Klinikgatan 22, 221 85, Lund, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Englund
authors.affiliation: Universiteit Gent, De Pintelaan 185, 9000, Ghent, Belgium.
authors.forename: R
authors.initials: R
authors.lastname: Verdonk
authors.affiliation: Orthopaedics Department, Centre Hospitalier de Versailles, 78150, Le Chesnay, France.
authors.forename: M
authors.initials: M
authors.lastname: Ollivier
authors.affiliation: Département de l'Appareil Locomoteur, Centre Hospitalier de Luxembourg - Clinique d' Eich, 78, Rue d'Eich, 1460, Luxembourg, Germany. seil.romain@chl.lu.|Sports Medicine Research Laboratory, Luxembourg Institute of Health, 78, Rue d'Eich, 1460, Luxembourg, Germany. seil.romain@chl.lu.
authors.forename: R
authors.initials: R
authors.lastname: Seil
mesh_terms: D000368:Aged; D000465:Algorithms; D001182:Arthroscopy / Q000379:methods*; D001859:Bone Neoplasms / Q000000981:diagnostic imaging; D002357:Cartilage Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D000072700:Conservative Treatment; D005060:Europe; D050723:Fractures, Bone / Q000000981:diagnostic imaging; D006801:Humans; D008279:Magnetic Resonance Imaging; D008592:Menisci, Tibial / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging; D017410:Practice Guidelines as Topic; D011859:Radiography; D012107:Research Design
keywords: Arthroscopic partial meniscectomy; Consensus; Degenerative Lesion; Management; Meniscus