“You’re stuck in the middle here”: a qualitative  study of GPs’ experiences of managing knee pain attributed to a degenerative meniscal  tear

Background Exercise is the recommended first-line therapy for a degenerative meniscal tear (DMT). Despite this,  knee pain attributed to DMTs are a common presentation to specialist orthopaedic clinics. In the primary care setting,  the general practitioner (GP) plays a central role in managing patients with knee pain, but to date their perspective  has not been explored in relation to DMTs. This study explored GPs’ experiences of managing people with knee pain  attributed to a DMT. Methods A qualitative research design was adopted and practices in the South and Mid-West of Ireland were  contacted via recruitment emails circulated through professional and research networks. Interested GPs contacted  the researchers via email, and purposive and snowball sampling was used for recruitment. Semi-structured interviews  were conducted online or over the telephone. Interviews were digitally recorded and transcribed. Data was analysed  using an inductive approach to thematic analysis. Ethical approval was granted by the Irish College of General  Practitioners (ICGP_REC_21_0031). Results Seventeen semi-structured one-on-one interviews were conducted. Three main themes were identified  with related subthemes: (1) GPs’ experiences of relational aspects of care, (2) GP beliefs about what constitutes best  care for patients with a DMT, and (3) how GP practice is enacted within the current healthcare setting. GPs described  the challenge of maintaining a strong clinical alliance, while managing perceived patient expectations of a ‘quick fix’  and advanced imaging. They reported slowing down clinical decisions and feeling ‘stuck’ with limited options when  conservative treatment had failed. GPs believed that exercise should be the core treatment for DMTs and emphasised  engaging patients in an active approach to recovery. Some GPs believed arthroscopy had a role in circumstances  where patients didn’t improve with physiotherapy. Limited access to public physiotherapy and orthopaedic services  hampered GPs’ management plans and negatively impacted patient outcomes. Conclusions GP beliefs around what constitutes best care for a DMT generally aligned with the evidence base.  Nonetheless, there was sometimes tension between these beliefs and the patient’s own treatment expectations.The ability to enact their beliefs was hampered by limited access to conservative management options, sometimes  leading to early escalation of care