International Delphi Consensus on Medial Meniscal Root Tears Shows High Agreement on Diagnosis, Treatment, and Rehabilitation but Lack of Agreement on Treatment of Asymptomatic Tears

Jorge Chahla; Jose Rafael Garcia; Luke Tollefson; Lika Dzidzishvili; Felicitas Allende; Cameron Gerhold; Aaron J. Krych; Robert F. LaPrade; Ashley J. Bassett; David L. Bernholt; Sanjeev Bhatia; Berte Bøe; Charles H. Brown; Kyu Sung Chung; Moisés Cohen; Lars Engebretsen; Filippo Familiari; Scott C. Faucett; Matthias J. Feucht; Takayuki Furumatsu; Andrew G. Geeslin; Alan M.J. Getgood; Takaaki Hiranaka; Eivind Inderhaug; C. Magaly Iñiguez; Darren L. Johnson; Jin Goo Kim; Sung Hwan Kim; Yuya Kodama; Elizaveta Kon; Sebastian Kopf; Christopher M. LaPrade; Christopher M. Larson; Dhong Won Lee; Martin Lind; Catherine A. Logan; Irene I. López-Torres; Timothy Lording; Rodrigo Maestu; Gilbert Moatshe; Jill K. Monson; Iain R. Murray; Volker Musahl; Roberto Negrin Vyhmeister; Yuki Okazaki; David Parker; Wolf Petersen; Jonathan C. Riboh; Romain Seil; Elvire Servien; Bertrand Sonnery-Cottet; Tim Spalding; Ciara Stevenson; Michael J. Stuart; Miho J. Tanaka; Sachin Tapasvi; Maria Tuca; Wybren A. van der Wal; Nikhil N. Verma; Richard PB von Bormann; Adam B. Yanke; Jorge Chahla

doi:10.1016/j.arthro.2025.06.028

International Delphi Consensus on Medial Meniscal Root Tears Shows High Agreement on Diagnosis, Treatment, and Rehabilitation but Lack of Agreement on Treatment of Asymptomatic Tears

Jorge Chahla^*, Jose Rafael Garcia, Luke Tollefson, Lika Dzidzishvili, Felicitas Allende, Cameron Gerhold, Aaron J. Krych, Robert F. LaPrade, Ashley J. Bassett, David L. Bernholt, Sanjeev Bhatia, Berte Bøe, Charles H. Brown, Kyu Sung Chung, Moisés Cohen, Lars Engebretsen, Filippo Familiari, Scott C. Faucett, Matthias J. Feucht, Takayuki FurumatsuAndrew G. Geeslin, Alan M.J. Getgood, Takaaki Hiranaka, Eivind Inderhaug, C. Magaly Iñiguez, Darren L. Johnson, Jin Goo Kim, Sung Hwan Kim, Yuya Kodama, Elizaveta Kon, Sebastian Kopf, Christopher M. LaPrade, Christopher M. Larson, Dhong Won Lee, Martin Lind, Catherine A. Logan, Irene I. López-Torres, Timothy Lording, Rodrigo Maestu, Gilbert Moatshe, Jill K. Monson, Iain R. Murray, Volker Musahl, Roberto Negrin Vyhmeister, Yuki Okazaki, David Parker, Wolf Petersen, Jonathan C. Riboh, Romain Seil, Elvire Servien, Bertrand Sonnery-Cottet, Tim Spalding, Ciara Stevenson, Michael J. Stuart, Miho J. Tanaka, Sachin Tapasvi, Maria Tuca, Wybren A. van der Wal, Nikhil N. Verma, Richard PB von Bormann, Adam B. Yanke, Jorge Chahla^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Research › peer-review

1 Citation (Scopus)

Abstract

PURPOSE: To develop an expert consensus statement on the diagnosis, management, and rehabilitation of medial meniscal root tears (MMRTs) using a modified Delphi technique.

METHODS: A working group developed statements on MMRT diagnosis, nonoperative management, surgical indications, surgical management, alignment, and rehabilitation using modified Delphi techniques. Fifty-six experts were surveyed over 3 rounds to reach consensus, with agreement measured on a 5-point Likert scale. Statements were included, revised, or excluded on the basis of predefined thresholds (≥75% agreement, <20% disagreement). Experts suggested revisions or new statements in the first 2 rounds, and final consensus statements were included.

RESULTS: All 56 experts completed 3 survey rounds. Experts agreed that root tears may occur with no known history of trauma, typically in older patients, and that it should be diagnosed with an magnetic resonance imaging. In symptomatic patients with MMRTs without advanced osteoarthritis should be repaired using an anatomic transtibial pull-out technique (performing a pie-crusting technique can be helpful for visualization). Nonoperative management is advised for patients with advanced osteoarthritis. High tibial osteotomy may be considered for significant varus malalignment during MMRT repair. The only statement without consensus was the management of asymptomatic MMRTs with mild medial compartment cartilage wear, indicating ongoing debate.

CONCLUSIONS: Overall, 98% of statements reached consensus. There is agreement that magnetic resonance imaging is the gold standard for diagnosis. Symptomatic MMRTs without advanced osteoarthritis should be repaired early using an anatomic transtibial pull-out technique. End-stage knee osteoarthritis warrants nonoperative management of MMRTs, and a structured postoperative protocol with limited weightbearing and range of motion is essential after repair. No agreement was reached on managing asymptomatic MMRTs in patients without significant medial compartment degeneration. Meniscal centralization sutures may help in cases of substantial extrusion, but their routine use is debated.

LEVEL OF EVIDENCE: Level V, consensus of expert opinion.

Original language	English
Journal	Arthroscopy - Journal of Arthroscopic and Related Surgery
Early online date	3 Jul 2025
DOIs	https://doi.org/10.1016/j.arthro.2025.06.028
Publication status	E-pub ahead of print - 3 Jul 2025
Externally published	Yes

Access to Document

10.1016/j.arthro.2025.06.028

Cite this

Chahla, J., Garcia, J. R., Tollefson, L., Dzidzishvili, L., Allende, F., Gerhold, C., Krych, A. J., LaPrade, R. F., Bassett, A. J., Bernholt, D. L., Bhatia, S., Bøe, B., Brown, C. H., Chung, K. S., Cohen, M., Engebretsen, L., Familiari, F., Faucett, S. C., Feucht, M. J., ... Chahla, J. (2025). International Delphi Consensus on Medial Meniscal Root Tears Shows High Agreement on Diagnosis, Treatment, and Rehabilitation but Lack of Agreement on Treatment of Asymptomatic Tears. Arthroscopy - Journal of Arthroscopic and Related Surgery. Advance online publication. https://doi.org/10.1016/j.arthro.2025.06.028

@article{08972ac62eed4061a49f63c2acc62615,

title = "International Delphi Consensus on Medial Meniscal Root Tears Shows High Agreement on Diagnosis, Treatment, and Rehabilitation but Lack of Agreement on Treatment of Asymptomatic Tears",

abstract = "PURPOSE: To develop an expert consensus statement on the diagnosis, management, and rehabilitation of medial meniscal root tears (MMRTs) using a modified Delphi technique.METHODS: A working group developed statements on MMRT diagnosis, nonoperative management, surgical indications, surgical management, alignment, and rehabilitation using modified Delphi techniques. Fifty-six experts were surveyed over 3 rounds to reach consensus, with agreement measured on a 5-point Likert scale. Statements were included, revised, or excluded on the basis of predefined thresholds (≥75\% agreement, <20\% disagreement). Experts suggested revisions or new statements in the first 2 rounds, and final consensus statements were included.RESULTS: All 56 experts completed 3 survey rounds. Experts agreed that root tears may occur with no known history of trauma, typically in older patients, and that it should be diagnosed with an magnetic resonance imaging. In symptomatic patients with MMRTs without advanced osteoarthritis should be repaired using an anatomic transtibial pull-out technique (performing a pie-crusting technique can be helpful for visualization). Nonoperative management is advised for patients with advanced osteoarthritis. High tibial osteotomy may be considered for significant varus malalignment during MMRT repair. The only statement without consensus was the management of asymptomatic MMRTs with mild medial compartment cartilage wear, indicating ongoing debate.CONCLUSIONS: Overall, 98\% of statements reached consensus. There is agreement that magnetic resonance imaging is the gold standard for diagnosis. Symptomatic MMRTs without advanced osteoarthritis should be repaired early using an anatomic transtibial pull-out technique. End-stage knee osteoarthritis warrants nonoperative management of MMRTs, and a structured postoperative protocol with limited weightbearing and range of motion is essential after repair. No agreement was reached on managing asymptomatic MMRTs in patients without significant medial compartment degeneration. Meniscal centralization sutures may help in cases of substantial extrusion, but their routine use is debated.LEVEL OF EVIDENCE: Level V, consensus of expert opinion.",

author = "Jorge Chahla and Garcia, \{Jose Rafael\} and Luke Tollefson and Lika Dzidzishvili and Felicitas Allende and Cameron Gerhold and Krych, \{Aaron J.\} and LaPrade, \{Robert F.\} and Bassett, \{Ashley J.\} and Bernholt, \{David L.\} and Sanjeev Bhatia and Berte B{\o}e and Brown, \{Charles H.\} and Chung, \{Kyu Sung\} and Mois{\'e}s Cohen and Lars Engebretsen and Filippo Familiari and Faucett, \{Scott C.\} and Feucht, \{Matthias J.\} and Takayuki Furumatsu and Geeslin, \{Andrew G.\} and Getgood, \{Alan M.J.\} and Takaaki Hiranaka and Eivind Inderhaug and \{Magaly I{\~n}iguez\}, C. and Johnson, \{Darren L.\} and Kim, \{Jin Goo\} and Kim, \{Sung Hwan\} and Yuya Kodama and Elizaveta Kon and Sebastian Kopf and LaPrade, \{Christopher M.\} and Larson, \{Christopher M.\} and Lee, \{Dhong Won\} and Martin Lind and Logan, \{Catherine A.\} and L{\'o}pez-Torres, \{Irene I.\} and Timothy Lording and Rodrigo Maestu and Gilbert Moatshe and Monson, \{Jill K.\} and Murray, \{Iain R.\} and Volker Musahl and Vyhmeister, \{Roberto Negrin\} and Yuki Okazaki and David Parker and Wolf Petersen and Riboh, \{Jonathan C.\} and Romain Seil and Elvire Servien and Bertrand Sonnery-Cottet and Tim Spalding and Ciara Stevenson and Stuart, \{Michael J.\} and Tanaka, \{Miho J.\} and Sachin Tapasvi and Maria Tuca and \{van der Wal\}, \{Wybren A.\} and Verma, \{Nikhil N.\} and \{von Bormann\}, \{Richard PB\} and Yanke, \{Adam B.\} and Jorge Chahla",

year = "2025",

month = jul,

day = "3",

doi = "10.1016/j.arthro.2025.06.028",

language = "English",

journal = "Arthroscopy - Journal of Arthroscopic and Related Surgery",

issn = "0749-8063",

publisher = "W.B. Saunders",

}

Chahla, J, Garcia, JR, Tollefson, L, Dzidzishvili, L, Allende, F, Gerhold, C, Krych, AJ, LaPrade, RF, Bassett, AJ, Bernholt, DL, Bhatia, S, Bøe, B, Brown, CH, Chung, KS, Cohen, M, Engebretsen, L, Familiari, F, Faucett, SC, Feucht, MJ, Furumatsu, T, Geeslin, AG, Getgood, AMJ, Hiranaka, T, Inderhaug, E, Magaly Iñiguez, C, Johnson, DL, Kim, JG, Kim, SH, Kodama, Y, Kon, E, Kopf, S, LaPrade, CM, Larson, CM, Lee, DW, Lind, M, Logan, CA, López-Torres, II, Lording, T, Maestu, R, Moatshe, G, Monson, JK, Murray, IR, Musahl, V, Vyhmeister, RN, Okazaki, Y, Parker, D, Petersen, W, Riboh, JC, Seil, R, Servien, E, Sonnery-Cottet, B, Spalding, T, Stevenson, C, Stuart, MJ, Tanaka, MJ, Tapasvi, S, Tuca, M, van der Wal, WA, Verma, NN, von Bormann, RPB, Yanke, AB & Chahla, J 2025, 'International Delphi Consensus on Medial Meniscal Root Tears Shows High Agreement on Diagnosis, Treatment, and Rehabilitation but Lack of Agreement on Treatment of Asymptomatic Tears', Arthroscopy - Journal of Arthroscopic and Related Surgery. https://doi.org/10.1016/j.arthro.2025.06.028

International Delphi Consensus on Medial Meniscal Root Tears Shows High Agreement on Diagnosis, Treatment, and Rehabilitation but Lack of Agreement on Treatment of Asymptomatic Tears. / Chahla, Jorge; Garcia, Jose Rafael; Tollefson, Luke et al.
In: Arthroscopy - Journal of Arthroscopic and Related Surgery, 03.07.2025.

Research output: Contribution to journal › Article › Research › peer-review

TY - JOUR

T1 - International Delphi Consensus on Medial Meniscal Root Tears Shows High Agreement on Diagnosis, Treatment, and Rehabilitation but Lack of Agreement on Treatment of Asymptomatic Tears

AU - Chahla, Jorge

AU - Garcia, Jose Rafael

AU - Tollefson, Luke

AU - Dzidzishvili, Lika

AU - Allende, Felicitas

AU - Gerhold, Cameron

AU - Krych, Aaron J.

AU - LaPrade, Robert F.

AU - Bassett, Ashley J.

AU - Bernholt, David L.

AU - Bhatia, Sanjeev

AU - Bøe, Berte

AU - Brown, Charles H.

AU - Chung, Kyu Sung

AU - Cohen, Moisés

AU - Engebretsen, Lars

AU - Familiari, Filippo

AU - Faucett, Scott C.

AU - Feucht, Matthias J.

AU - Furumatsu, Takayuki

AU - Geeslin, Andrew G.

AU - Getgood, Alan M.J.

AU - Hiranaka, Takaaki

AU - Inderhaug, Eivind

AU - Magaly Iñiguez, C.

AU - Johnson, Darren L.

AU - Kim, Jin Goo

AU - Kim, Sung Hwan

AU - Kodama, Yuya

AU - Kon, Elizaveta

AU - Kopf, Sebastian

AU - LaPrade, Christopher M.

AU - Larson, Christopher M.

AU - Lee, Dhong Won

AU - Lind, Martin

AU - Logan, Catherine A.

AU - López-Torres, Irene I.

AU - Lording, Timothy

AU - Maestu, Rodrigo

AU - Moatshe, Gilbert

AU - Monson, Jill K.

AU - Murray, Iain R.

AU - Musahl, Volker

AU - Vyhmeister, Roberto Negrin

AU - Okazaki, Yuki

AU - Parker, David

AU - Petersen, Wolf

AU - Riboh, Jonathan C.

AU - Seil, Romain

AU - Servien, Elvire

AU - Sonnery-Cottet, Bertrand

AU - Spalding, Tim

AU - Stevenson, Ciara

AU - Stuart, Michael J.

AU - Tanaka, Miho J.

AU - Tapasvi, Sachin

AU - Tuca, Maria

AU - van der Wal, Wybren A.

AU - Verma, Nikhil N.

AU - von Bormann, Richard PB

AU - Yanke, Adam B.

AU - Chahla, Jorge

PY - 2025/7/3

Y1 - 2025/7/3

N2 - PURPOSE: To develop an expert consensus statement on the diagnosis, management, and rehabilitation of medial meniscal root tears (MMRTs) using a modified Delphi technique.METHODS: A working group developed statements on MMRT diagnosis, nonoperative management, surgical indications, surgical management, alignment, and rehabilitation using modified Delphi techniques. Fifty-six experts were surveyed over 3 rounds to reach consensus, with agreement measured on a 5-point Likert scale. Statements were included, revised, or excluded on the basis of predefined thresholds (≥75% agreement, <20% disagreement). Experts suggested revisions or new statements in the first 2 rounds, and final consensus statements were included.RESULTS: All 56 experts completed 3 survey rounds. Experts agreed that root tears may occur with no known history of trauma, typically in older patients, and that it should be diagnosed with an magnetic resonance imaging. In symptomatic patients with MMRTs without advanced osteoarthritis should be repaired using an anatomic transtibial pull-out technique (performing a pie-crusting technique can be helpful for visualization). Nonoperative management is advised for patients with advanced osteoarthritis. High tibial osteotomy may be considered for significant varus malalignment during MMRT repair. The only statement without consensus was the management of asymptomatic MMRTs with mild medial compartment cartilage wear, indicating ongoing debate.CONCLUSIONS: Overall, 98% of statements reached consensus. There is agreement that magnetic resonance imaging is the gold standard for diagnosis. Symptomatic MMRTs without advanced osteoarthritis should be repaired early using an anatomic transtibial pull-out technique. End-stage knee osteoarthritis warrants nonoperative management of MMRTs, and a structured postoperative protocol with limited weightbearing and range of motion is essential after repair. No agreement was reached on managing asymptomatic MMRTs in patients without significant medial compartment degeneration. Meniscal centralization sutures may help in cases of substantial extrusion, but their routine use is debated.LEVEL OF EVIDENCE: Level V, consensus of expert opinion.

AB - PURPOSE: To develop an expert consensus statement on the diagnosis, management, and rehabilitation of medial meniscal root tears (MMRTs) using a modified Delphi technique.METHODS: A working group developed statements on MMRT diagnosis, nonoperative management, surgical indications, surgical management, alignment, and rehabilitation using modified Delphi techniques. Fifty-six experts were surveyed over 3 rounds to reach consensus, with agreement measured on a 5-point Likert scale. Statements were included, revised, or excluded on the basis of predefined thresholds (≥75% agreement, <20% disagreement). Experts suggested revisions or new statements in the first 2 rounds, and final consensus statements were included.RESULTS: All 56 experts completed 3 survey rounds. Experts agreed that root tears may occur with no known history of trauma, typically in older patients, and that it should be diagnosed with an magnetic resonance imaging. In symptomatic patients with MMRTs without advanced osteoarthritis should be repaired using an anatomic transtibial pull-out technique (performing a pie-crusting technique can be helpful for visualization). Nonoperative management is advised for patients with advanced osteoarthritis. High tibial osteotomy may be considered for significant varus malalignment during MMRT repair. The only statement without consensus was the management of asymptomatic MMRTs with mild medial compartment cartilage wear, indicating ongoing debate.CONCLUSIONS: Overall, 98% of statements reached consensus. There is agreement that magnetic resonance imaging is the gold standard for diagnosis. Symptomatic MMRTs without advanced osteoarthritis should be repaired early using an anatomic transtibial pull-out technique. End-stage knee osteoarthritis warrants nonoperative management of MMRTs, and a structured postoperative protocol with limited weightbearing and range of motion is essential after repair. No agreement was reached on managing asymptomatic MMRTs in patients without significant medial compartment degeneration. Meniscal centralization sutures may help in cases of substantial extrusion, but their routine use is debated.LEVEL OF EVIDENCE: Level V, consensus of expert opinion.

UR - https://www.scopus.com/pages/publications/105012529435

U2 - 10.1016/j.arthro.2025.06.028

DO - 10.1016/j.arthro.2025.06.028

M3 - Article

C2 - 40614908

AN - SCOPUS:105012529435

SN - 0749-8063

JO - Arthroscopy - Journal of Arthroscopic and Related Surgery

JF - Arthroscopy - Journal of Arthroscopic and Related Surgery

ER -

Chahla J, Garcia JR, Tollefson L, Dzidzishvili L, Allende F, Gerhold C et al. International Delphi Consensus on Medial Meniscal Root Tears Shows High Agreement on Diagnosis, Treatment, and Rehabilitation but Lack of Agreement on Treatment of Asymptomatic Tears. Arthroscopy - Journal of Arthroscopic and Related Surgery. 2025 Jul 3. Epub 2025 Jul 3. doi: 10.1016/j.arthro.2025.06.028

International Delphi Consensus on Medial Meniscal Root Tears Shows High Agreement on Diagnosis, Treatment, and Rehabilitation but Lack of Agreement on Treatment of Asymptomatic Tears

Abstract

Access to Document

Other files and links

Fingerprint

Cite this