2024 American Academy of Orthopaedic Surgeons (AAOS) Clinical Practice Guideline: An interpretation of the diagnosis and management of acute isolated meniscal injury_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XIONG Qianjiang ^1,2 , HU Yunan ^1,2 , FAN Lei ^1,2 , LI Jian ^1,2 ,  FU Weili ^1,2

1. Sports Medicine Center, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;
2. Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;

Corresponding?author：

FU Weili, Email: foxwin2008@163.com

Keywords：

Acute isolated meniscal injury; treatment; clinical practice guideline; guideline interpretation

DOI：

10.7507/1002-1892.202601059

Video：

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Acute isolated meniscal injury is a common sports-related knee injury in clinical practice. In June 2024, the American Academy of Orthopaedic Surgeons (AAOS) released the latest Clinical Practice Guideline for the Management of Acute Isolated Meniscal Pathology. Based on rigorous evidence-based methodology, the guideline provides systematic recommendations regarding physical examination, imaging evaluation, and both non-operative and operative management strategies, classifying these recommendations according to the strength of evidence. This article aims to interpret the key points in the diagnosis and management of acute isolated meniscal injury, to inform clinical practice and guide future research.

Citation： XIONG Qianjiang, HU Yunan, FAN Lei, LI Jian, FU Weili. 2024 American Academy of Orthopaedic Surgeons (AAOS) Clinical Practice Guideline: An interpretation of the diagnosis and management of acute isolated meniscal injury. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(3): 358-363. doi: 10.7507/1002-1892.202601059 Copy

1.	Whittaker JL, Losciale JM, Juhl CB, et al. Risk factors for knee osteoarthritis after traumatic knee injury: a systematic review and meta-analysis of randomised controlled trials and cohort studies for the OPTIKNEE Consensus. Br J Sports Med, 2022, 56(24): 1406-1421.
2.	Gee SM, Tennent DJ, Cameron KL, et al. The burden of meniscus injury in young and physically active populations. Clin Sports Med, 2020, 39(1): 13-27.
3.	Adams BG, Houston MN, Cameron KL. The epidemiology of meniscus injury. Sports Med Arthrosc Rev, 2021, 29(3): e24-e33.
4.	Snoeker BA, Bakker EW, Kegel CA, et al. Risk factors for meniscal tears: a systematic review including meta-analysis. J Orthop Sports Phys Ther, 2013, 43(6): 352-367.
5.	Chandran A, Morris SN, Powell JR, et al. Epidemiology of injuries in national collegiate athletic association men’s football: 2014—2015 through 2018—2019. J Athl Train, 2021, 56(7): 643-650.
6.	Brophy RH, Best MJ. Academy of Orthopaedic Surgeons clinical practice guideline summary: Management of acute isolated meniscal pathology. J Am Acad Orthop Surg, 2025, 33(13): e724-e730.
7.	Kopf S, Beaufils P, Hirschmann MT, et al. Management of traumatic meniscus tears: the 2019 ESSKA meniscus consensus. Knee Surg Sports Traumatol Arthrosc, 2020, 28(4): 1177-1194.
8.	American Academy of Orthopaedic Surgeons. Acute Isolated Meniscal Pathology: Evidence-Based Clinical Practice Guideline[EB/OL]. (2024-06-10) [2026-01-10]. http://www.aaos.org/ampcpg.
9.	Goossens P, Keijsers E, van Geenen RJ, et al. Validity of the Thessaly test in evaluating meniscal tears compared with arthroscopy: a diagnostic accuracy study. J Orthop Sports Phys Ther, 2015, 45(1): 18-24.
10.	Syal A, Chudasama CH. Clinical examination, magnetic resonance imaging and arthroscopic correlations of ligament and menisci injuries of knee joint. Journal of Arthroscopy and Joint Surgery, 2015, 2(1): 3-8.
11.	Porter M, Shadbolt B. Accuracy of standard magnetic resonance imaging sequences for meniscal and chondral lesions versus knee arthroscopy. A prospective case-controlled study of 719 cases. ANZ J Surg, 2021, 91(6): 1284-1289.
12.	Wang W, Li Z, Peng HM, et al. Accuracy of MRI diagnosis of meniscal tears of the knee: A meta-analysis and systematic review. J Knee Surg, 2021, 34(2): 121-129.
13.	Phelan N, Rowland P, Galvin R, et al. A systematic review and meta-analysis of the diagnostic accuracy of MRI for suspected ACL and meniscal tears of the knee. Knee Surg Sports Traumatol Arthrosc, 2016, 24(5): 1525-1539.
14.	El-Hagrasy AMA, Theckayil AJ, Khan MA, et al. Magnetic resonance imaging is an effective first-line noninvasive tool for meniscal tear detection: A retrospective comparative analysis with knee arthroscopy. Arthrosc Sports Med Rehabil, 2024, 7(2): 101065. doi: 10.1016/j.asmr.2024.101065.
15.	Zhang S, Chen G, Li R, et al. Guidelines on the diagnosis and treatment of lateral meniscal lesions: A consensus statement by the chinese society of sports medicine. Orthop J Sports Med, 2022, 10(12): 23259671221138082. doi: 10.1177/23259671221138082.
16.	Yang S, Zhang S, Li R, et al. Chinese experts consensus and practice guideline on discoid lateral meniscus. Orthop Surg, 2023, 15(4): 915-929.
17.	Stein T, Mehling AP, Welsch F, et al. Long-term outcome after arthroscopic meniscal repair versus arthroscopic partial meniscectomy for traumatic meniscal tears. Am J Sports Med, 2010, 38(8): 1542-1548.
18.	Hurmuz M, Ionac M, Hogea B, et al. Osteoarthritis development following meniscectomy vs. meniscal repair for posterior medial meniscus injuries: A systematic review. Medicina (Kaunas), 2024, 60(4): 569. doi: 10.3390/medicina60040569.
19.	Stone RG, Barber FA. The posterior medial complex disruption. Orthopedics, 1988, 11(5): 741-746.
20.	Prill R, Ma CB, Wong SE, et al. The formal EU-US Meniscus Rehabilitation 2024 Consensus: An ESSKA-AOSSM-AASPT initiative. Part Ⅱ-Prevention, non-operative treatment and return to sport. Knee Surg Sports Traumatol Arthrosc, 2025, 33(8): 3014-3024.
21.	van der List JP, Daniel S, Blom I, et al. Early meniscal repair leads to higher success rates than delayed meniscal repair: A systematic review and meta-analysis. Am J Sports Med, 2025, 53(11): 2761-2770.
22.	Sadoghi P, Widhalm HK, Fischmeister MF, et al. Delayed meniscus repair lowers the functional outcome of primary ACL reconstruction. J Clin Med, 2024, 13(5): 1325. doi: 10.3390/jcm13051325.
23.	Gan JZ, Lie DT, Lee WQ. Clinical outcomes of meniscus repair and partial meniscectomy: Does tear configuration matter? J Orthop Surg (Hong Kong), 2020, 28(1): 2309499019887653. doi: 10.1177/2309499019887653.
24.	Ro KH, Kim JH, Heo JW, et al. Clinical and radiological outcomes of meniscal repair versus partial meniscectomy for medial meniscus root tears: A systematic review and meta-analysis. Orthop J Sports Med, 2020, 8(11): 2325967120962078. doi: 10.1177/2325967120962078.
25.	Sedgwick MJ, Saunders C, Getgood AMJ. Systematic review and meta-analysis of clinical outcomes following meniscus repair in patients 40 years and older. Orthop J Sports Med, 2024, 12(8): 23259671241258974. doi: 10.1177/23259671241258974.
26.	Sochacki KR, Varshneya K, Calcei JG, et al. Comparing meniscectomy and meniscal repair: A matched cohort analysis utilizing a national insurance database. Am J Sports Med, 2020, 48(10): 2353-2359.
27.	Zhou Y, Yang Q, Kang J, et al. Clinical effect of medial meniscus posterior root repair combined with centralization technique in the treatment of medial meniscus posterior root tears. BMC Musculoskelet Disord, 2024, 25(1): 982. doi: 10.1186/s12891-024-08125-2.
28.	蘇家榮, 孫鐵錚. 內側半月板后根撕裂研究進展. 中國運動醫學雜志, 2021, 40(9): 721-728.
29.	Kaminski R, Kulinski K, Kozar-Kaminska K, et al. Repair augmentation of unstable, complete vertical meniscal tears with bone marrow venting procedure: A prospective, randomized, double-blind, parallel-group, placebo-controlled study. Arthroscopy, 2019, 35(5): 1500-1508.
30.	Dean CS, Chahla J, Matheny LM, et al. Outcomes after biologically augmented isolated meniscal repair with marrow venting are comparable with those after meniscal repair with concomitant anterior cruciate ligament reconstruction. Am J Sports Med, 2017, 45(6): 1341-1348.
31.	李龍飛. 關節鏡下半月板縫合+骨髓刺激技術對半月板損傷患者膝關節功能、活動度的影響. 中國醫學創新, 2024, 21(35): 38-42.
32.	周琦, 張頡鴻, 祝云利, 等. 關節鏡下半月板縫合結合骨髓刺激治療半月板水平撕裂20例報告. 中國運動醫學雜志, 2015, 34(8): 735-738.
33.	趙曉非, 米豫飛, 王戰朝. 半月板縫合聯合骨髓刺激對半月板損傷患者膝關節功能的改善作用. 實用中西醫結合臨床, 2024, 24(5): 31-34.
34.	Pujol N, Salle De Chou E, Boisrenoult P, et al. Platelet-rich plasma for open meniscal repair in young patients: any benefit? Knee Surg Sports Traumatol Arthrosc, 2015, 23(1): 51-58.
35.	Griffin JW, Hadeed MM, Werner BC, et al. Platelet-rich plasma in meniscal repair: does augmentation improve surgical outcomes? Clin Orthop Relat Res, 2015, 473(5): 1665-1672.
36.	Abram SGF, Beard DJ, Price AJ, et al. Arthroscopic meniscal surgery: a national society treatment guideline and consensus statement. Bone Joint J, 2019, 101-B(6): 652-659.
37.	McHugh CG, Matzkin EG, Katz JN. Mechanical symptoms and meniscal tear: a reappraisal. Osteoarthritis Cartilage, 2022, 30(2): 178-183.
38.	Pujol N, Giordano AO, Wong SE, et al. The formal EU-US Meniscus Rehabilitation 2024 Consensus: An ESSKA-AOSSM-AASPT initiative. Part Ⅰ-Rehabilitation management after meniscus surgery (meniscectomy, repair and reconstruction). Knee Surg Sports Traumatol Arthrosc, 2025, 33(8): 3002-3013.
39.	Schweizer C, Hanreich C, Tscholl PM, et al. Meniscal repair outcome in 3829 patients with a minimum follow-up from 2 years up to 5 years: A meta-analysis on the overall failure rate and factors influencing failure. Am J Sports Med, 2024, 52(3): 822-831.
40.	Nepple JJ, Block AM, Eisenberg MT, et al. Meniscal repair outcomes at greater than 5 years: A systematic review and meta-analysis. J Bone Joint Surg (Am), 2022, 104(14): 1311-1320.
41.	Rosso C, Kovtun K, Dow W, et al. Comparison of all-inside meniscal repair devices with matched inside-out suture repair. Am J Sports Med, 2011, 39(12): 2634-2639.
42.	馮建豪, 徐一宏, 徐衛東. 膝關節半月板損傷修補術的研究進展. 中國修復重建外科雜志, 2023, 37(7): 885-894.

1. Whittaker JL, Losciale JM, Juhl CB, et al. Risk factors for knee osteoarthritis after traumatic knee injury: a systematic review and meta-analysis of randomised controlled trials and cohort studies for the OPTIKNEE Consensus. Br J Sports Med, 2022, 56(24): 1406-1421.
2. Gee SM, Tennent DJ, Cameron KL, et al. The burden of meniscus injury in young and physically active populations. Clin Sports Med, 2020, 39(1): 13-27.
3. Adams BG, Houston MN, Cameron KL. The epidemiology of meniscus injury. Sports Med Arthrosc Rev, 2021, 29(3): e24-e33.
4. Snoeker BA, Bakker EW, Kegel CA, et al. Risk factors for meniscal tears: a systematic review including meta-analysis. J Orthop Sports Phys Ther, 2013, 43(6): 352-367.
5. Chandran A, Morris SN, Powell JR, et al. Epidemiology of injuries in national collegiate athletic association men’s football: 2014—2015 through 2018—2019. J Athl Train, 2021, 56(7): 643-650.
6. Brophy RH, Best MJ. Academy of Orthopaedic Surgeons clinical practice guideline summary: Management of acute isolated meniscal pathology. J Am Acad Orthop Surg, 2025, 33(13): e724-e730.
7. Kopf S, Beaufils P, Hirschmann MT, et al. Management of traumatic meniscus tears: the 2019 ESSKA meniscus consensus. Knee Surg Sports Traumatol Arthrosc, 2020, 28(4): 1177-1194.
8. American Academy of Orthopaedic Surgeons. Acute Isolated Meniscal Pathology: Evidence-Based Clinical Practice Guideline[EB/OL]. (2024-06-10) [2026-01-10]. http://www.aaos.org/ampcpg.
9. Goossens P, Keijsers E, van Geenen RJ, et al. Validity of the Thessaly test in evaluating meniscal tears compared with arthroscopy: a diagnostic accuracy study. J Orthop Sports Phys Ther, 2015, 45(1): 18-24.
10. Syal A, Chudasama CH. Clinical examination, magnetic resonance imaging and arthroscopic correlations of ligament and menisci injuries of knee joint. Journal of Arthroscopy and Joint Surgery, 2015, 2(1): 3-8.
11. Porter M, Shadbolt B. Accuracy of standard magnetic resonance imaging sequences for meniscal and chondral lesions versus knee arthroscopy. A prospective case-controlled study of 719 cases. ANZ J Surg, 2021, 91(6): 1284-1289.
12. Wang W, Li Z, Peng HM, et al. Accuracy of MRI diagnosis of meniscal tears of the knee: A meta-analysis and systematic review. J Knee Surg, 2021, 34(2): 121-129.
13. Phelan N, Rowland P, Galvin R, et al. A systematic review and meta-analysis of the diagnostic accuracy of MRI for suspected ACL and meniscal tears of the knee. Knee Surg Sports Traumatol Arthrosc, 2016, 24(5): 1525-1539.
14. El-Hagrasy AMA, Theckayil AJ, Khan MA, et al. Magnetic resonance imaging is an effective first-line noninvasive tool for meniscal tear detection: A retrospective comparative analysis with knee arthroscopy. Arthrosc Sports Med Rehabil, 2024, 7(2): 101065. doi: 10.1016/j.asmr.2024.101065.
15. Zhang S, Chen G, Li R, et al. Guidelines on the diagnosis and treatment of lateral meniscal lesions: A consensus statement by the chinese society of sports medicine. Orthop J Sports Med, 2022, 10(12): 23259671221138082. doi: 10.1177/23259671221138082.
16. Yang S, Zhang S, Li R, et al. Chinese experts consensus and practice guideline on discoid lateral meniscus. Orthop Surg, 2023, 15(4): 915-929.
17. Stein T, Mehling AP, Welsch F, et al. Long-term outcome after arthroscopic meniscal repair versus arthroscopic partial meniscectomy for traumatic meniscal tears. Am J Sports Med, 2010, 38(8): 1542-1548.
18. Hurmuz M, Ionac M, Hogea B, et al. Osteoarthritis development following meniscectomy vs. meniscal repair for posterior medial meniscus injuries: A systematic review. Medicina (Kaunas), 2024, 60(4): 569. doi: 10.3390/medicina60040569.
19. Stone RG, Barber FA. The posterior medial complex disruption. Orthopedics, 1988, 11(5): 741-746.
20. Prill R, Ma CB, Wong SE, et al. The formal EU-US Meniscus Rehabilitation 2024 Consensus: An ESSKA-AOSSM-AASPT initiative. Part Ⅱ-Prevention, non-operative treatment and return to sport. Knee Surg Sports Traumatol Arthrosc, 2025, 33(8): 3014-3024.
21. van der List JP, Daniel S, Blom I, et al. Early meniscal repair leads to higher success rates than delayed meniscal repair: A systematic review and meta-analysis. Am J Sports Med, 2025, 53(11): 2761-2770.
22. Sadoghi P, Widhalm HK, Fischmeister MF, et al. Delayed meniscus repair lowers the functional outcome of primary ACL reconstruction. J Clin Med, 2024, 13(5): 1325. doi: 10.3390/jcm13051325.
23. Gan JZ, Lie DT, Lee WQ. Clinical outcomes of meniscus repair and partial meniscectomy: Does tear configuration matter? J Orthop Surg (Hong Kong), 2020, 28(1): 2309499019887653. doi: 10.1177/2309499019887653.
24. Ro KH, Kim JH, Heo JW, et al. Clinical and radiological outcomes of meniscal repair versus partial meniscectomy for medial meniscus root tears: A systematic review and meta-analysis. Orthop J Sports Med, 2020, 8(11): 2325967120962078. doi: 10.1177/2325967120962078.
25. Sedgwick MJ, Saunders C, Getgood AMJ. Systematic review and meta-analysis of clinical outcomes following meniscus repair in patients 40 years and older. Orthop J Sports Med, 2024, 12(8): 23259671241258974. doi: 10.1177/23259671241258974.
26. Sochacki KR, Varshneya K, Calcei JG, et al. Comparing meniscectomy and meniscal repair: A matched cohort analysis utilizing a national insurance database. Am J Sports Med, 2020, 48(10): 2353-2359.
27. Zhou Y, Yang Q, Kang J, et al. Clinical effect of medial meniscus posterior root repair combined with centralization technique in the treatment of medial meniscus posterior root tears. BMC Musculoskelet Disord, 2024, 25(1): 982. doi: 10.1186/s12891-024-08125-2.
28. 蘇家榮, 孫鐵錚. 內側半月板后根撕裂研究進展. 中國運動醫學雜志, 2021, 40(9): 721-728.
29. Kaminski R, Kulinski K, Kozar-Kaminska K, et al. Repair augmentation of unstable, complete vertical meniscal tears with bone marrow venting procedure: A prospective, randomized, double-blind, parallel-group, placebo-controlled study. Arthroscopy, 2019, 35(5): 1500-1508.
30. Dean CS, Chahla J, Matheny LM, et al. Outcomes after biologically augmented isolated meniscal repair with marrow venting are comparable with those after meniscal repair with concomitant anterior cruciate ligament reconstruction. Am J Sports Med, 2017, 45(6): 1341-1348.
31. 李龍飛. 關節鏡下半月板縫合+骨髓刺激技術對半月板損傷患者膝關節功能、活動度的影響. 中國醫學創新, 2024, 21(35): 38-42.
32. 周琦, 張頡鴻, 祝云利, 等. 關節鏡下半月板縫合結合骨髓刺激治療半月板水平撕裂20例報告. 中國運動醫學雜志, 2015, 34(8): 735-738.
33. 趙曉非, 米豫飛, 王戰朝. 半月板縫合聯合骨髓刺激對半月板損傷患者膝關節功能的改善作用. 實用中西醫結合臨床, 2024, 24(5): 31-34.
34. Pujol N, Salle De Chou E, Boisrenoult P, et al. Platelet-rich plasma for open meniscal repair in young patients: any benefit? Knee Surg Sports Traumatol Arthrosc, 2015, 23(1): 51-58.
35. Griffin JW, Hadeed MM, Werner BC, et al. Platelet-rich plasma in meniscal repair: does augmentation improve surgical outcomes? Clin Orthop Relat Res, 2015, 473(5): 1665-1672.
36. Abram SGF, Beard DJ, Price AJ, et al. Arthroscopic meniscal surgery: a national society treatment guideline and consensus statement. Bone Joint J, 2019, 101-B(6): 652-659.
37. McHugh CG, Matzkin EG, Katz JN. Mechanical symptoms and meniscal tear: a reappraisal. Osteoarthritis Cartilage, 2022, 30(2): 178-183.
38. Pujol N, Giordano AO, Wong SE, et al. The formal EU-US Meniscus Rehabilitation 2024 Consensus: An ESSKA-AOSSM-AASPT initiative. Part Ⅰ-Rehabilitation management after meniscus surgery (meniscectomy, repair and reconstruction). Knee Surg Sports Traumatol Arthrosc, 2025, 33(8): 3002-3013.
39. Schweizer C, Hanreich C, Tscholl PM, et al. Meniscal repair outcome in 3829 patients with a minimum follow-up from 2 years up to 5 years: A meta-analysis on the overall failure rate and factors influencing failure. Am J Sports Med, 2024, 52(3): 822-831.
40. Nepple JJ, Block AM, Eisenberg MT, et al. Meniscal repair outcomes at greater than 5 years: A systematic review and meta-analysis. J Bone Joint Surg (Am), 2022, 104(14): 1311-1320.
41. Rosso C, Kovtun K, Dow W, et al. Comparison of all-inside meniscal repair devices with matched inside-out suture repair. Am J Sports Med, 2011, 39(12): 2634-2639.
42. 馮建豪, 徐一宏, 徐衛東. 膝關節半月板損傷修補術的研究進展. 中國修復重建外科雜志, 2023, 37(7): 885-894.

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2024 American Academy of Orthopaedic Surgeons (AAOS) Clinical Practice Guideline: An interpretation of the diagnosis and management of acute isolated meniscal injury

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