Causation Review - Meniscal Tears. Classification Of Meniscal Tears Of The Knee And The Evidence That Certain Tears Are Degenerative In Origin; Including The Relationship Of Meniscal Tears To Knee Osteoarthritis

This causation review summarises information on the classification of meniscal tears of the knee and the outlines the evidence that certain tears are often degenerative in origin. It is not intended to replace clinical judgement, or be used as a clinical protocol. A reasonable attempt has been made to find and review papers relevant to the focus of this report but it is not exhaustive. The content does not necessarily represent the official view of ACC or represent ACC policy. Summary Background In this report the clinical and physiological associations, natural history and causation of knee meniscal tears is reviewed and evidence presented to assist ACC decide which types of meniscal tear in relation to the subject and situation are likely to be due predominately to a traumatic injury event and therefore compensable and which are predominately due to non-injury causes. (Evidence of best treatment options is only noted in this review). The terminology that describes certain tears as 'traumatic' or 'degenerative' is widespread in the medical literature and widely accepted as a broad concept. This paper reviews the evidence for this terminology to assess its reasonableness. For reasons of simplicity the current classification of traumatic or degenerate is used in the paper while seeking the evidence for it. Meniscal tears are a common orthopaedic diagnosis and partial meniscectomy is the most frequent surgical procedure performed by orthopaedic surgeons in the United States with more than 50% of the procedures performed in patients 45 years and older. ACC data Because ACC does not collect detailed surgical procedure codes it is not known how many procedures are done that include repair or resection of knee menisci. It is believed that a high proportion of knee arthroscopies however would include these procedures. Between July 2008 and June 2009 ACC paid for 8999 simple and complex knee arthroscopic procedures at a total cost of $29,275,965. These figures exclude those coded for anterior cruciate ligament (ACL) reconstruction and knee arthroscopic procedures that proceeded to open surgery. The costs only refer to the elective surgery costs; costs for subsequent workers compensation etc., are not included. The highest arthroscopic rate of intervention in the year 08/09 expressed as a rate per 1000 of population occurred in the 50 to 59 age year group when the rate just exceeded 4; the next highest rate occurred in the 40 to 49 years olds and then the 60 to …