Meniscal trimming

Meniscal trimming is a minor surgical procedure to remove a frayed inner edge of a knee meniscus. It is also referred to as 'arthroscopic partial meniscectomy' (APM).

Page updated June 2024 by Dr Sheila Strover (Clinical Editor)

 

The controversy about meniscal trimming

When a knee surgeon is investigating symptoms suggestive of a torn meniscus, X-rays and scans may not give a clear answer.

It is generally appropriate to suggest to the patient that the surgeon takes a look inside the joint via arthroscopy. If the menisci look a bit 'tatty' around the edges it is tempting for the surgeon to trim back to healthy meniscal cartilage.

The procedure is known as 'arthroscopic trimming' or 'arthroscopic partial meniscectomy (APM)' and the practice has earned a bad reputation.

There are several relevant issues here:

  1. the remuneration for a purely diagnostic arthroscopy and that for arthroscopic partial meniscectomy are very different
  2. there is pressure from the patient to 'do something' and not to simply note the problem
  3. a bombshell publication in 2013 literature suggests that simply washing out the joint is as effective or more effective than trimming the damage away, and some papers suggest that trimming in the older patient may indeed speed up the onset of arthritis rather than slow it down.

  4. The original peer-reviewed paper that triggered the debate and a quotation from the summary:

    "....arthroscopic partial medial meniscectomy provides no significant benefit over sham surgery in patients with a degenerative meniscal tear and no knee osteoarthritis. These results argue against the current practice of performing arthroscopic partial meniscectomy in patients with a degenerative meniscal tear...."

    [Citation: Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear]

 

  • Quote from peer-reviewed paper:

    "....Meniscus surgery has come a long way from the old slogan, “If it is torn, take it out!” to the currently accepted slogan, “Save the meniscus!”"....

    Citation: Doral MN, Bilge O, Huri G, Turhan E, Verdonk R. Modern treatment of meniscal tears. EFORT Open Rev. 2018 May 21;3(5):260-268. doi: 10.1302/2058-5241.3.170067. PMID: 29951265; PMCID: PMC5994634.

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Trimming a meniscus

Video of the surgical procedure of meniscal trimming, courtesy of Dr Ram Venkatesh

 

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Forum discussions

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Synonyms: 
arthroscopic partial meniscectomy
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Dr Sheila Strover (Editor)
BSc (Hons), MB BCh, MBA

See biography...

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