Centre Hospitalier de Luxembourg-Clinique d'Eich; Luxembourg Institute of Research in Orthopaedics; Luxembourg Institute of Health.
St. Marguerite Hospital.
Arthroscopy. 2021 May;37(5):1554-1556. doi: 10.1016/j.arthro.2021.02.035.
The 20-year progression of osteoarthritis (OA) after arthroscopic partial meniscectomy (APM) in patients aged between 50 and 70 bears a long-term risk of conversion to total knee arthroplasty of 15.7%. Negative predictors at the time of surgery are the degree of knee OA, lateral meniscectomy, age at surgery, and malalignment. This confirms the evolution of the natural history of knee OA, but most importantly, it provides arguments to further restrain indications of APM in degenerative meniscus lesions (DMLs). An improved understanding of the consequences of APM for DMLs allows to increasingly limit the indications of this procedure, thus rendering it pertinent and efficient. Over the last years, the numbers of APM have been declining in several countries. This reduction required many surgeons to undergo a paradigm shift. This change cannot be induced by an anathema but by educational programs and guidelines based on broad consensus of the surgical communities, like the 2016 European Meniscus Consensus Project initiated by the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA). It provided a reference frame for the management of DMLs, based both on scientific literature and balanced expert opinion. The proposed decisional algorithm introduced APM not as a first- but as a second-line treatment of DMLs in symptomatic patients. A recent survey presented earlier this month at the international conference "The Meniscus" among ESSKA members showed that a majority of the 460 respondents were familiar with the ESSKA consensus and that 66% of them changed their practice following its publication. Paradigm changes take time. The history of meniscus repair showed that it takes many years to develop medical and surgical practice. And there is a good reason for this. Paradigms are not fashionable that come and go with the seasons. The medical and orthopaedic communities need to get them right by improving clinical science and balancing discussions.
在 50 至 70 岁之间接受关节镜部分半月板切除术 (APM) 的患者，20 年后骨关节炎 (OA) 的进展会带来 15.7%的膝关节置换的长期风险。手术时的负面预测因素包括膝关节 OA 的严重程度、外侧半月板切除术、手术时的年龄和对线不良。这证实了膝关节 OA 自然史的演变，但最重要的是，它为进一步限制退行性半月板病变 (DML) 的 APM 指征提供了依据。对 APM 治疗 DML 后果的认识不断提高，使得该手术的适应证不断减少，从而使该手术变得合理且有效。近年来，一些国家的 APM 数量有所下降。这种减少要求许多外科医生转变观念。这种转变不能通过诅咒来实现，而只能通过基于外科界广泛共识的教育计划和指南来实现，例如由欧洲运动创伤学、膝关节外科和关节镜学会 (ESSKA) 发起的 2016 年欧洲半月板共识项目。该项目为 DML 的管理提供了一个参考框架，既基于科学文献，也基于平衡的专家意见。所提出的决策算法将 APM 不是作为 DML 症状患者的一线治疗，而是作为二线治疗引入。本月早些时候在 ESSKA 成员参加的国际会议“半月板”上提出的一项最新调查显示，460 名受访者中有多数人熟悉 ESSKA 共识，其中 66%的人在其发布后改变了自己的实践。观念转变需要时间。半月板修复的历史表明，它需要多年的时间来发展医学和外科实践。这是有充分理由的。观念不会随着季节的变化而时髦地来来去去。医学和骨科界需要通过提高临床科学水平和平衡讨论来正确把握。
