2021 - The future of meniscus science: international expert consensus

The future of meniscus science: international expert consensus

DePhillipo NN, LaPrade RF, Zaffagnini S, Mouton C, Seil R, Beaufils P. The future of meniscus science: international expert consensus. J Exp Orthop. 2021 Mar 31;8(1):24. doi: 10.1186/s40634-021-00345-y. PMID: 33791890; PMCID: PMC8012449.

This is the editor's interpretation of a paper published in the orthopaedic literature in 2021 - our attempt to make relevant medical articles accessible to lay readers. If you wish to read the original just click through the link above.

In this study the authors sent a questionnaire to a panel of experts - 82 faculty members (primarily orthopaedic surgeons) of the 5th International Conference on Meniscus Science and Surgery (of whom 76 replied).

Outcome of the survey

Analysis of the survey highlighted the fact that there is still a lack of long term studies of the newer meniscal techniques, but the following are main areas for ongoing research -

• meniscus preservation and management of post-traumatic osteoarthritis, including osteotomy, biologics, cartilage resurfacing, pharmaceuticals
• meniscus repair, including intra-articular repair devices and biologic augmentation
• surgical medical devices
• biologics during surgery - including autologous blood, bone marrow aspirate, platelet-rich plasma, adipose tisse and amniotic fluid
• meniscus engineering, including 3D printing for meniscal scaffolds
• meniscus transplantation
• non-surgical medical devices, including unloader braces

and the respondents identified several areas where they felt that meniscus science should focus -

• meniscal preservation techniques of meniscus repair, particularly addressing meniscal extrusion, and the use of orthobiologics
• 3-D printing for meniscal transplants/scaffolds, personalised treatment, and bioengineering for artificial implants.

The authors point out why the science is still new - it was only in 1948 that the first medical paper drew attention to degenerative changes in a knee meniscus, but by the 1980s, and with the advent of keyhold surgery, it became clear that the knee meniscus was a most important structure. A paradigm shift occurred from a routine of simply removing a problematic meniscus to saving or replacing it where possible in order to retain the best function of the patient's knee and avoid the onset of post-traumatic osteoarthritis. So the science is still evolving.