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A healthy 52-year-old male who runs for 40 minutes 4–5 times per week comes to your office because he has recently noted pain in the inner aspect of his right knee along the joint line. He also reports mild swelling and stiffness in his knee along with a “clicking” sensation when he flexes and extends it. In addition, he says that at unpredictable times he feels like his knee “might give way.” During the examination he reports pain along the medial joint line with palpation, and the McMurray test is positive. A subsequent MRI demonstrates a degenerative tear in the lateral portion of the medial meniscus with no significant degenerative arthritis. You begin to discuss a management plan with him, considering various surgical and nonsurgical options. 

Given this patient’s age and clinical findings, which one of the following has been shown to produce better long-term outcomes than conservative management?

A. Intra-articular corticosteroids
B. Hylan GF 20 (Synvisc)
C. Arthroscopic meniscectomy
D. Arthroscopic meniscus repair
E. No additional treatment strategies

ANSWER: E

A systematic review found that arthroscopic procedures for degenerative meniscal tears in middle-aged adults with little or no arthritis do not significantly improve long-term pain or function compared to conservative management consisting of physical therapy and a standardized exercise program. No studies have compared conservative management to intra-articular injections of corticosteroids or hylan GF 20 for managing degenerative meniscal tears, either alone or when combined with conservative management.

Ref: Khan M, Evaniew N, Bedi A, et al: Arthroscopic surgery for degenerative tears of the meniscus: A systematic review and meta-analysis. CMAJ 2014;186(14):1057-1064. 2) Ebell MH: No long-term benefit of arthroscopic surgery for meniscal tears in middle-aged persons. Am Fam Physician 2015;91(9):643.