Arthroscopic surgery for meniscal tears
Best Practice Guidance
Arthroscopy of the knee is a surgical technique where a camera and instruments are inserted into the knee through small incisions, usually under general anaesthesia. Following a detailed systematic assessment of the important structures within the knee joint a surgical procedure is performed which can involve repair or resection of meniscal tissue, with or without other associated procedures such as ligament reconstruction or repair of articular cartilage lesions. The British Association for surgery of the Knee (BASK) recently published guidelines for the use of arthroscopic surgery to treat degenerate meniscal tears.
This guidance applies to adults and children.
The use of arthroscopic surgery to treat degenerate meniscal tears should follow published BASK guidelines.
Rationale for recommendation
Meniscal tears in the knee are a common finding and in many cases are not related to any significant symptoms. They are often associated with degenerative articular cartilage change and osteoarthritis within the knee. A significant number of patients who present with persistent and often mechanical symptoms within the knee have a meniscal tear, which may be noted with an MRI scan.
The vast majority of patients with a meniscal tear should be initially treated non-operatively and should not have arthroscopic meniscectomy as a firstline treatment. Non-operative treatment is highly effective with patient education using verbal and written materials, physiotherapy and weight loss interventions. Exercise should comprise both local muscle strengthening and general aerobic fitness. Paracetamol and topical NSAIDs should be firstline pharmacological pain management strategies. Many patients treated this way will improve and do not require surgery.
There are a number of occasions when arthroscopic meniscal surgery can be considered as a first-line treatment. Firstly, patients who have a locked knee need urgent assessment. If a bucket handle tear of the meniscus is present, most cases need arthroscopic repair or resection of the meniscus.
Secondly where the patient has had an acute injury and an MRI scan reveals a potentially repairable meniscus tear, an arthroscopic meniscal repair should be considered.
Where symptoms have not settled after three months of non-operative treatment an MRI scan should be considered. In these cases with an unstable meniscal tear on MRI, arthroscopic meniscal surgery may be indicated. Recent systematic review evidence has suggested that in these cases where there are persistent symptoms, there can be improvement with this procedure.
Patients considering arthroscopic knee surgery should go through a shared decision-making process and have a good understanding of the risks of surgery. The procedure is a relatively safe intervention but does carry a low a low risk of infection and deep vein thrombosis, both of which are serious complications.
Routine use of arthroscopy for degenerative knee disease, where no specific target pathology has been identified (e.g. proven meniscal tear and persistent symptoms), is not recommended. Use of arthroscopy in patients with generic degenerative knee disease and no specific target pathology has not been found to be clinically beneficial and is unlikely to be cost-effective. Using agreed guidelines for employing arthroscopic surgery to treat meniscal tear pathology and avoiding indiscriminative use will reduce unwarranted variation in clinical care.
There is no specific EBI patient guidance for this intervention.
However, we recommend using the BRAN principles (Benfits, Risks, Alternatives and do Nothing) when speaking with patients about this.
Further information on patient involvement in EBI can be found on the EBI for patients section.
WHEN (LEFT(der.Spell_Dominant_Procedure,4) in ('W821','W822','W823','W828','W829') OR (LEFT(der.Spell_Dominant_Procedure,4) = 'W714' and (APCS.der_procedure_all like '%Y767%' and APCS.der_procedure_all like '%Z846%')) OR (LEFT(der.Spell_Dominant_Procedure,4) = 'W715' and (APCS.der_procedure_all like '%Y767%' and APCS.der_procedure_all like '%Z846%’)) ) AND (APCS.Der_Diagnosis_All like '%M232%' OR (APCS.Der_Diagnosis_All like '%M233%' and APCS.Der_Diagnosis_All like '%M238%')) AND APCS.der_diagnosis_all not like '%S832%' AND APCS.Admission_Method not like ('2%’) THEN ‘2E_arthroscopic_surgery'
Procedure codes (OPCS)
W714 Open autologous chondrocyte implantation into articular structure
W715 Open stem cell implantation into articular structure
Y767 Arthroscopic approach to joint (secondary to W714/W715)
Z846 Knee joint (secondary to W714/W715 and Y767)
W821 Endoscopic total excision meniscus of knee joint
W822 Endoscopic resection of meniscus of knee joint
W823 Endoscopic repair of meniscus of knee joint
W824 Endoscopic total replacement of meniscus of knee joint
W825 Endoscopic partial replacement of meniscus of knee joint
W828 Other specified therapeutic endoscopic operations on meniscus of knee joint
W829 Unspecified therapeutic endoscopic operations on meniscus of knee joint
Diagnosis codes (ICD)
M232 Derangement of meniscus due to old tear or injury
M238 Other internal derangements of knee (with M232/3)
S832 Tear of meniscus, current
M233 Other meniscus derangements
apcs.der_diagnosis_all not like '%C[0-9][0-9]%' and apcs.der_diagnosis_all not like '%D0%' and apcs.der_diagnosis_all not like '%D3%' and apcs.der_diagnosis_all not like '%D4%’
This code captures code in the ranges C00-C99, D00-D09 and D37-D48.
Age range: the codes use the following age ranges 0-18 for children and 19-120
— Private Appointment Exclusion
- Kise NJ, Risberg MA, Stensrud S, Ranstam J, Engebretsen L, Roos EM. Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow up. BMJ 2016;354:i3740. doi:10.1136/bmj.i3740 pmid:27440192
- Khan M, Evaniew N, Bedi A, Ayeni OR, Bhandari M. Arthroscopic surgery for degenerative tears of the meniscus: a systematic review and meta-analysis. CMAJ2014;186:1057-64. doi:10.1503/cmaj.140433.
- Thorlund JB, Juhl CB, Roos EM, Lohmander LS. Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms. BMJ2015;350:h2747. doi:10.1136/bmj.h2747
- Devji T, Guyatt GH, Lytvyn L, et al. Application of minimal important differences in degenerative knee disease outcomes: a systematic review and case study to inform BMJ Rapid Recommendations. BMJ Open 2017;7:e015587. doi:10.1136/bmjopen-2016-015587.
- Brignardello-Peterson R, Guyatt GH, Schandelmaier S, et al. Knee arthroscopy versus conservative management in patients with degenerative knee disease: a systematic review. BMJ Open2017;7:e016114. doi:10.1136/bmjopen-2017-016114.
- Marsh JD, Birmingham TB, Giffin JR, et al. Cost-effectiveness analysis of arthroscopic surgery compared with non-operative management for osteoarthritis of the knee. BMJ Open2016;6:e009949.
- National Institute for Health and Clinical Excellence. Osteoarthritis: care and management. Clinical guideline [CG177] (2014)
- McGrory B, Weber K, Lynott JA, et al. American Academy of Orthopaedic Surgeons. The American Academy of Orthopaedic Surgeons evidence based clinical practice guideline on surgical management of osteoarthritis of the knee. J Bone Joint Surg Am2016;98:688-92. doi:10.2106/JBJS.15.01311pmid:27098328.
- National Institute for Health and Clinical Excellence. Arthroscopic knee washout, with or without debridement, for the treatment of osteoarthritis (Interventional procedures guidance IPG230). (2007)
- Adelani MA, Harris AH, Bowe TR, Giori NJ. Arthroscopy for knee osteoarthritis has not decreased after a clinical trial. Clin Orthop Relat Res2016;474:489-94. doi:10.1007/s11999-015-4514-4 pmid:26290345.
- Siemieniuk RAC, Harris IA, Agoritsas T, et al. Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline. BMJ 2017;257:j1982. doi:10.1136/bmj.j1982.
- Gauffin H, Tagesson S, Meunier A, Magnusson H, Kvist J. Knee arthroscopic surgery is beneficial to middle-aged patients with meniscal symptoms: a prospective, randomised, single-blinded study. Osteoarthritis Cartilage2014;22:1808-16. doi:10.1016/j.joca.2014.07.017 pmid:25086401.
- Sihvonen R, Englund M, Turkiewicz A, Järvinen TL. Finnish Degenerative Meniscal Lesion Study Group. Mechanical symptoms and arthroscopic partial meniscectomy in patients with degenerative meniscus tear: a secondary analysis of a randomized trial. Ann Intern Med2016;164:449-55. doi:10.7326/M15-0899 pmid:26856620.
- F. Abram, D. J. Beard, A. J. Price, BASK Meniscal Working Group. Bone Joint J 2019;101-B:652–659. Arthroscopic meniscal surgery a national society treatment guideline and consensus statement: https://doi.org/10.1302/0301-620X.101B6.BJJ-2019-0126.R1.
- Price, F. S. Haddad, D. J. Beard. Bone Joint J 2019;101-B:625–626. New guidelines for the use of arthroscopic meniscal knee surgery. Published Online:1 Jun 2019: https://doi.org/10.1302/0301-620X.101B6.BJJ-2019-0550.
- Abram SGF, Judge A, Beard DJ, Price AJ. Lancet. 2018 Nov 17;392(10160):2194-2202. Adverse outcomes after arthroscopic partial meniscectomy: a study of 700 000 procedures in the national Hospital Episode Statistics database for England. doi: 10.1016/S0140-6736(18)31771-9. Epub 2018 Sep 24.
- Abram SGF, Hopewell S, Monk AP, et al Arthroscopic partial meniscectomy for meniscal tears of the knee: a systematic review and meta-analysis. British Journal of Sports Medicine 2020;54:652-663.
- Abram SGF, Beard DJ, Price AJ, and BASK Meniscal Working Group. 2019. Arthroscopic meniscal surgery. The Bone & Joint Journal 2019 101-B:6, 652-65
- Abram SGF, Beard DJ, Price AJ, and BASK Meniscal Working Group National consensus on the definition, investigation, and classification of meniscal lesions of the knee. The Knee doi: https://doi.org/10.1016/j.knee.2018.06.001
How up to date is this information?
Last revised December 2023
December 2023 - Coding updated. August 2022 - Coding updated