Introduction

Meniscal tears in young (<40 years) patients may lead to functional disabilities in short-term, and increased risk of knee osteoarthritis (OA) in the long-term compared to persons without meniscal tears [1,2]. The choice of surgical treatment for meniscal tears is considered important to improve patient-reported pain and functional outcomes, and to potentially reduce the risk of people developing knee OA [3,4].

Arthroscopic partial meniscectomy (APM) is the most common orthopaedic procedure for treating meniscal tears worldwide, with several million procedures performed annually [3,5]. Nevertheless, current evidence suggests that meniscal repair may be the most favorable meniscal surgery in terms of restoring/preserving meniscal function, returning to sports, and protecting cartilage, rather than removing the damaged parts of the meniscus [6,7]. Most importantly, meniscal repair has been considered to provide better protection against the development of knee OA compared to APM [4,8,9]. Consequently, it has also been suggested that meniscal repair is more cost-effective than APM [10].

Despite these advantages, meniscal repair results in more re-interventions (∼25% in ACL intact knees for meniscal repair compared to ∼4% for APM up to 10 years after surgery), a higher complication rate, and less improvement in patient-reported outcomes [[11], [12], [13], [14]]. A significant limitation is that current evidence is based on observational studies with high risk of confounding by indication, i.e. risk of comparison of selected patients with different prognosis. No RCTs have compared APM vs repair for isolated meniscal tears in young patients [14]. However, performing a randomized controlled trial (RCT) is difficult due to strong treatment preferences among surgeons. One of the main arguments for surgeons not to randomize patients with a meniscal tear, is the amount of vascularization in the affected area. If the tear is in the vascularized red-red zone of the meniscus, orthopaedic surgeons are reluctant to perform APM, as the meniscus can potentially heal in this zone if treated with meniscal repair [15].

To inform a future multicentre RCT we aimed to explore orthopaedic surgeons’ willingness-to-randomize meniscal tear patients and their treatment preferences.