AAOS Board of Directors Approves Clinical Practice Guideline for Management of Acute Isolated Meniscal Pathology

During its June meeting, the AAOS Board of Directors approved the evidence-based AAOS Clinical Practice Guideline (CPG) for Acute Isolated Meniscal Pathology (AMP). This guideline is designed to aid clinicians in the treatment of patients suspected of or diagnosed with an acute isolated meniscal tear. It is not intended for patients with concurrent ligament issues such as anterior cruciate ligament tears, nor is it appropriate for those suspected to have chronic or degenerative meniscal tears.

The AMP CPG yielded one strong and two moderate-strength recommendations. The strong recommendation on advanced imaging favors MRI as the preferred method to diagnose acute meniscal tears due to its high accuracy. The CPG also included two moderate-strength recommendations: one advocating for surgical techniques that prioritize the preservation of meniscal tissue to reduce the risk for osteoarthritis of the knee and another suggesting that combining physical examination, including joint tenderness assessment, with the McMurray and Thessaly tests may enhance the accuracy of diagnosing acute isolated meniscal tears.

In addition to the three recommendations, the CPG offers seven options. Options are used when there is little, conflicting, or no evidence regarding a topic. These options included three limited-strength options and four consensus options. The limited-strength options in this CPG highlights that patients with an acute meniscal tear who have not responded to conservative treatment might benefit from surgical intervention within 6 months of the injury. Additionally, bone marrow venting or platelet-rich plasma could be considered for patients undergoing surgical repair for an isolated meniscal tear, as their use may enhance healing and improve clinical outcomes. The final limited-strength option compares meniscus repair and partial meniscectomy, indicating that repair might lead to enhanced patient-reported outcomes.

Representatives from the American Academy of Physical Medicine and Rehabilitation, National Athletic Trainers’ Association, American Society for Sports Medicine, American Physical Therapy Association, Pediatric Orthopaedic Society of North America, and American Medical Society for Sports Medicine participated in the development of this guideline.

This CPG and accompanying documentation are available at orthoguidelines.org.