Perelli, Simone

AbstractPurposePart two of this consensus aimed to provide recommendations for the prevention of meniscus injuries, non‐operative treatment of acute tears and degenerative lesions, return to sports and patient‐reported outcome measures.MethodsThis consensus followed the European Society of Knee Surgery, Sports Traumatology and Arthroscopy (ESSKA) formal consensus methodology. For this combined ESSKA—American Orthopedic Society for Sports Medicine (AOSSM)—American Academy of Sports Physical Therapy (AASPT) initiative, 67 experts from 14 countries, including orthopedic surgeons and physiotherapists, were involved. The 26 Steering Group members established guiding questions, screened the existing evidence, and proposed statements, and provided Grades of recommendations. The 41 Rating Group members assessed the statements according to a Likert scale (1–9). Final documents were assessed by an international peer review group for geographical adaptability.ResultsLow to moderate scientific level of evidence was available, so that grades of recommendations were low (three Grade A ratings, four Grade B, three Grade C and 13 Grade D), underlining the relevance of this consensus. One strong and 17 relative agreements with overall median of 8 (8–9) and a mean of 7.92 ± 0.37 were achieved for 23 statements on 18 questions. Prevention of meniscus injuries is possible with general knee injury reduction programmes and through avoidance of certain activities. Non‐operative treatment including physical therapy is the first line approach for degenerative meniscus lesions and may be an option for some acute tears. Return to sports after meniscus tear surgery should be both criterion‐based and time‐based. Patient reported outcomes in combination with performance‐based measures are recommended to evaluate the rehabilitation process.ConclusionThis international EU–US consensus established recommendations for prevention strategies, describes rehabilitation of non‐operated patients and of patients after partial meniscectomy, meniscus repair and meniscus reconstruction, and establishes return to sport criteria. These updated and structured recommendations may be applied by surgeons and physiotherapists.Level of EvidenceLevel I, consensus.

AbstractDespite the fact that the choice of bearing design has been thought to influence the functional outcomes and longevity of unicompartimental knee arthroplasty (UKA), there is a lack of clinical evidence supporting the decision‐making process in patients who have undergone high tibial osteotomy (HTO). A systematic review of studies was carried out that reported the outcomes of fixed‐bearing (FB) or mobile‐bearing (MB) medial UKA in patients with a previous HTO. A random effect meta‐analysis using a generalized linear mixed‐effects model to calculate revision rates was done. Seven retrospective cohort studies were included for this study. Regarding the fixation method, 40 were the FB‐UKA and 47 were MB‐UKA. For both groups, the mean post‐operative follow‐up was 5.8 years. The survival rates were 92% for the FB‐UKA with a mean follow‐up of 10 years. For the MB‐UKA, it ranged from 35.7 to 93%, with a mean follow‐up of 4.2 years. For the FB, the time to revision was reported as 9.3 years, while 1.2, 2.5 and 2.91 years was reported for the MB. The results of the meta‐analysis showed that the revision rate for the patients receiving a FB‐UKA after failed HTO was 8%, compared to 17% in those who received an MB‐UKA. The results of the review suggest that the use of the FB‐UKA is associated with lower revision rates and a longer survival time than the MB‐UKA and have similar functional ability scores.Level of evidence: III (systematic review of level‐III studies).