Editorial commentary: Surgical management of degenerative meniscus lesions is a second- but not a first-line treatment.

The 20-year progression of osteoarthritis (OA) after arthroscopic partial meniscectomy (APM) in patients aged between 50 and 70 bears a long-term risk of conversion to total knee arthroplasty of 15.7%. Negative predictors at the time of surgery are the degree of knee OA, lateral meniscectomy, age at surgery, and malalignment. This confirms the evolution of the natural history of knee OA, but most importantly, it provides arguments to further restrain indications of APM in degenerative meniscus lesions (DMLs). An improved understanding of the consequences of APM for DMLs allows to increasingly limit the indications of this procedure, thus rendering it pertinent and efficient. Over the last years, the numbers of APM have been declining in several countries. This reduction required many surgeons to undergo a paradigm shift. This change cannot be induced by an anathema but by educational programs and guidelines based on broad consensus of the surgical communities, like the 2016 European Meniscus Consensus Project initiated by the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA). It provided a reference frame for the management of DMLs, based both on scientific literature and balanced expert opinion. The proposed decisional algorithm introduced APM not as a first- but as a second-line treatment of DMLs in symptomatic patients. A recent survey presented earlier this month at the international conference "The Meniscus" among ESSKA members showed that a majority of the 460 respondents were familiar with the ESSKA consensus and that 66% of them changed their practice following its publication. Paradigm changes take time. The history of meniscus repair showed that it takes many years to develop medical and surgical practice. And there is a good reason for this. Paradigms are not fashionable that come and go with the seasons. The medical and orthopaedic communities need to get them right by improving clinical science and balancing discussions.