Is knee meniscectomy recommended for the geriatric population?

Knee Meniscectomy in the Geriatric Population: Not Recommended

Knee meniscectomy is not recommended for geriatric patients with degenerative knee disease due to lack of benefit and potential harms. 1

Evidence Against Meniscectomy in Older Adults

• The BMJ clinical practice guideline makes a strong recommendation against arthroscopic knee surgery, including meniscectomy, for patients with degenerative knee disease, which is particularly common in the geriatric population 1
• Arthroscopic surgery does not result in meaningful improvement in long-term pain or function for older patients with degenerative knee disease 1
• The American Academy of Orthopaedic Surgeons (AAOS) recommends against performing arthroscopy with débridement or lavage in patients with a primary diagnosis of symptomatic osteoarthritis of the knee 1
• While some patients may experience small improvements in pain or function at three months post-surgery, these benefits are not sustained at one year 1
• Surgical treatment subjects geriatric patients to increased risks including anesthetic complications, infection, and thrombophlebitis 1

Specific Risks for Geriatric Patients

• Osteonecrosis has been reported as a complication following arthroscopic meniscectomy in elderly patients, with persistent knee pain and joint effusion after the procedure 2
• Older patients with pre-existing moderate or marked degenerative changes have only a 21% chance of good or excellent results following meniscectomy 3
• Patients over 70 years with advanced osteoarthritis (grade 3-4) have significantly worse outcomes, with 45% requiring additional surgery within 1-4 years 4

Limited Exceptions

• Arthroscopic partial meniscectomy may be considered as an option only in specific cases where patients have:

  • Primary signs and symptoms of a torn meniscus and/or a loose body 1
  • Mild osteoarthritis with a clear traumatic history 5
  • No significant pre-existing degenerative changes 4

• A positive McMurray sign may favor the diagnosis of a traumatic tear versus degenerative changes, but with only 67% specificity, it has limited utility in clinical decision-making for geriatric patients 6

Alternative Management Approaches

• Conservative management should be the first-line approach for geriatric patients with knee pain 1
• Options include:
  • Watchful waiting
  • Weight loss if overweight
  • Physical therapy and exercise
  • Oral or topical pain medications such as NSAIDs
  • Intra-articular corticosteroid injections 1

Decision Algorithm

1. Assess for degenerative knee disease (common in patients >50 years)
2. Evaluate radiographic evidence of osteoarthritis (Kellgren-Lawrence grade)
3. If K-L grade ≥3, avoid meniscectomy (only 55% satisfaction rate) 4
4. If K-L grade 0-2 with clear traumatic history and positive McMurray sign, consider meniscectomy only after failed conservative management 5, 6
5. For all other geriatric patients, pursue conservative management options 1

Key Caveat

The distinction between traumatic tears and degenerative changes is often difficult to make clinically in older patients, and even with apparent traumatic tears, outcomes are generally worse than in younger populations 6, 4. The presence of any degenerative changes significantly reduces the likelihood of successful outcomes with meniscectomy in the geriatric population 3.