The treatment, patient expectations and outcomes of patients with a meniscal tear in current clinical practice

A large body of evidence has demonstrated that surgery does not provide additional benefit when compared to non-operative treatment in older patients with meniscal tears. There is not the same degree of evidence for younger patients e.g. those under 55 years. The aim of this thesis is to explore the treatment, experiences and outcomes of patients aged 18 to 55 years with a meniscal tear to further improve our understanding of this population. An evaluation of MRI knee reports performed at a large NHS trust was performed to identify the frequency of each diagnosis and the proportion of patients that present to secondary care and undergo operative management. Despite meniscal tears being more common than previously reported, less than 50% of patients present to secondary care and 20% undergo surgery. A systematic review found regardless of treatment, patient outcomes improved over six months before plateauing. In the medium term, arthroscopic partial meniscectomy led to higher outcome scores compared to non-operative measures although this was not clinically significant. A qualitative systematic review and interview study added new evidence on patient experiences and expectations of treatment. Patients believed surgery provides a definitive solution and physiotherapy would not ‘fix the tear’. A multicentre cohort study described the characteristics and outcomes of patients aged 18 to 55 years with a meniscal tear. No baseline characteristics, including tear type or mechanical symptoms, were found to affect 12-month patient reported outcome scores. Surgery led to significant improvements in 12-month outcomes indicating a possible benefit of surgery in this population which requires further exploration with a randomised trial. The previous evidence and current national meniscal tear treatment guidelines may not be representative and appropriate based on the evidence in this thesis. Further research and up to date treatment guidelines is required in light of the evidence presented