Summary of diagnostics related to DMT and indications for APM

An Expert Consensus Statement (Hohmann et al. 2020) Diagnostics: Joint line tenderness present (85% agreement). Gradual onset of activity-related pain. Lack of extension present. Localized pain, mechanical symptoms, short duration, normal radiographs. In the presence of OA (Kellgren 1/2) clinical examination in particular localized tenderness reliable. Indication for surgery: Persistent pain, effusion, failed conservative treatment(< 3 months), should have surgery. If there are mechanical symptoms (clicking, grinding), surgery is the first line of treatment. British Association for Surgery of the Knee (BASK) Meniscal Consensus Project (Abram et al. 2019a) Diagnostics: Target meniscal lesion with corresponding symptoms and signs. Possible target meniscal lesion with corresponding symptoms and signs ESSKA Meniscus Consensus Project (Kopf et al. 2020) Diagnostics: There is very limited evidence that pain in the degenerative knee is directly attributable to a degenerative meniscus lesion even if the lesion is considered to be unstable. Indication for surgery: Surgery should not be proposed as a FIRST line of treatment of degenerative meniscus lesions (Jones 1909), Grade After 3 months with nonoperative treatment and persistent pain/mechanical symptoms. Surgery can be proposed earlier for patients presenting considerable mechanical symptoms Australian Knee Society Position Statement (Australian Knee Society 2017) Indication for surgery: Symptomatic nonrepairable meniscal tears after the failure of an appropriate trial of a structured rehabilitation program ISAKOS: Consensus statements across three continents (Stone et al. 2017a) Diagnostics: Nonetheless, symptoms in [those with little to no osteoarthritis on plain radiographs], especially when chronic, more likely represent meniscal pathology in contrast to those with more significant arthritis, whose symptoms may derive from a more complex constellation of pain generators (synovitis, chondral damage, osteophytosis, free flaps, loose bodies, etc.) Indication for surgery: For knees with little to no arthritis, if the patient’s symptoms have proved refractory to comprehensive, multimodal non-surgical management, arthroscopic surgery can be considered. This applies especially to patients with well-localized joint line pain with acute (or acute on chronic) mechanical symptoms in a well-aligned knee Dutch Orthopaedic Association (Van Arkel et al. 2021) Diagnostics: Do not perform arthroscopy based on 1 or more meniscus tests without additional information from history, physical examination, and any additional radiological examination Indication for surgery: Start with nonoperative treatment in degenerative meniscus injury. Consider treating nonoperatively for at least 3 months in the event of a meniscal tear.