Arthroscopic meniscectomy for knee osteoarthritis: the gap between evidence based medicine and expert opinion.

For many decades arthroscopy considered to be the least invasive procedure among all surgical interventions for treatment of knee osteoarthritis (OA). In the beginning of XXI century several randomized clinical studies (RCS) demonstrated inefficiency of lavage and debridement for knee OA. The evidence regarding partial meniscectomy for these category of patients remained uncertain. Therefore the published clinical guidelines are either controversial or inconclusive. 
The aim of this study was to critically review the current RCS and meta-analyses of RCS as well as actual clinical guidelines of international orthopedic societies and compare them to expert opinions. 
We searched PubMed and E-library databases for high evidence research published from 2015 to 2022 and analyzed the current clinical guidelines dedicated to partial meniscectomy for knee OA. 60 specialized in this field orthopedic surgeons interviewed anonymously to clarify the decision making process in real clinical practice 
The evidence is that more than 2/3 of knee OA patients with degenerative meniscal tear benefit from non-surgical treatment therefore indication for arthroscopic partial meniscectomy is limited. The majority of current clinical guidelines consider surgery as an second option if conservative treatment failed and only for non-advanced knee OA. On the contrary experts interview demonstrated the lack of standardized approach as well as a lot of controversies in clinical decision making. 
The future research dedicated to partial meniscectomy in knee OA should be appropriately designed to clearly differentiate the sub-population of patient who may benefit from arthroscopy in the long-term without carrying the risk of rapid disease progression with premature conversion to arthroplasty.