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Cance N, Rouchaud A, Chousta A, Josse A, James Dan M, Chotel F. Dynamic Magnetic Resonance Imaging Protocol: An Effective and Useful Tool to Assess Discoid Lateral Meniscus Instability in Children. J Pediatr Orthop 2024:01241398-990000000-00582. [PMID: 38860515 DOI: 10.1097/bpo.0000000000002747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
OBJECTIVES One of the most common symptoms in cases of discoid lateral meniscus (DLM) in children is a "snapping" knee. The clock in extension, followed by a pop in flexion, perceived by the clinician, reflects the meniscal displacement caused by the peripheral meniscocapsular detachment. Standard magnetic resonance imaging (MRI) results in a 40% false-negative rate for detecting this instability. The hypothesis was that a dynamic MRI protocol could reduce the false negative rate and improve the efficiency of the MRI in detecting the direction of instability. METHODS Eight DLM knees (8 patients) with snapping knees (grade 2 of Lyon's classification) were included in this monocentric prospective preliminary study in a referral center of pediatric orthopaedic surgery. Every patient underwent a dynamic MRI protocol with both T2-Fat-Sat sagittal and coronal slices, performed "after the clock" and again "after the pop" in a knee with standard 20 degrees of flexion during acquisition. All the MRI data were correlated with an arthroscopic description of the peripheral tear of the DLM according to Ahn's classification to assess for diagnostic accuracy. RESULTS The standard MRI protocol resulted in a false-negative rate of 50% for detecting the direction of instability. The dynamic MRI protocol allowed the identification of, and classification of the meniscal instability, meniscal shift, and meniscocapsular tear in 8 of 8 patients (0% false-negative rate), perfectly correlated with arthroscopic findings. CONCLUSION This preliminary series, although short, allowed us to understand all the types of movements and lesions associated with the child's discoid meniscus. The detailed case analysis showed a strong benefit of such a protocol for planning the surgical suture procedure. The functionality and reliability of the dynamic MRI protocol is a good and method relatively simple method which does not require specific equipment, minimizing any additional cost compared with standard MRI. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Nicolas Cance
- Department of Pediatric Orthopaedic Surgery
- Department of Orthopaedic Surgery, Lyon Ortho Clinic, Clinique de la Sauvegarde
| | - Aymeric Rouchaud
- Department of Pediatric Radiology, Lyon University Hospital for Mother and Children, Bron
| | - Aygulph Chousta
- Department of Pediatric Radiology, Lyon University Hospital for Mother and Children, Bron
| | | | - Michael James Dan
- Department of Orthopaedic Surgery, Lyon Ortho Clinic, Clinique de la Sauvegarde
- Department of Orthopaedic Surgery, East Coast Athletic Orthopaedics, Merewether, NSW, Australia
| | - Franck Chotel
- Department of Pediatric Orthopaedic Surgery
- Claude Bernard University, Lyon, France
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Cance N, Dan MJ, Bauwens PH, Commeureuc J, Vandergugten S, Chotel F. Absorbable Sutures Repair Without Meniscopexy, Results in Superior Outcomes for Discoid Lateral Meniscus With Meniscocapsular Anterior Detachment in Children. J Pediatr Orthop 2024; 44:e457-e462. [PMID: 38477312 DOI: 10.1097/bpo.0000000000002667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
BACKGROUND Despite the fact that meniscocapsular anterior detachment is the most common location of instability in children with a Discoid Lateral Meniscus (DLM), there is a lack of consensus about the type of repair that should be utilized for stabilization. The aim of this study was to determine the best fixation method for anterior detachment of DLM in children. Our hypothesis was that excessive rigidity with fixation would restrict meniscal mobility and increase the rate of failure or prevent full knee flexion. METHODS This study was a retrospective single-center study consisting of 51 consecutive knees (45 children) with menico-capsular anterior detachment that underwent stabilization and minimal saucerization of the meniscus between 2007 and 2018. We aimed to compare the need for revision surgery and knee flexion between the different types of fixations utilized; namely we compared meniscopexy using anchors on the tibia (n=30) with outside-in arthroscopic soft tissue fixation (n=21), and absorbable (n=18) and nonabsorbable sutures (n=33) were compared. RESULTS The mean age at surgery was 10.4 years (3 to 17) with a mean follow-up of 52 months (18 to 148). The group of knees treated with absorbable sutures had a significantly better rate of full knee flexion (15/18) compared with the nonabsorbable group (17/33) ( P =0.03). Despite the absence of significance ( P =007), there was a lower rate of revision surgery due to suture failure in the soft tissue fixation group (0 revision operations) compared with the meniscopexy group (5 revision operations). CONCLUSIONS For anterior meniscocapsular detachment of DLM, it is recommended to perform soft tissue fixation with absorbable sutures, as this technique resulted in better knee flexion and a lower rate of revision surgery when compared with meniscopexy and nonabsorbable suture fixation. LEVEL OF EVIDENCE Level III-retrospective case studies.
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Affiliation(s)
- Nicolas Cance
- Department of pediatric Orthopaedic Surgery, Lyon University Hospital for Mother and Children, Bron
- Orthopedic Surgery Department, Lyon Ortho Clinic, Clinique de la Sauvegarde, Lyon, France
| | - Michael J Dan
- Orthopedic Surgery Department, Lyon Ortho Clinic, Clinique de la Sauvegarde, Lyon, France
- Surgical and Orthopaedic Research Laboratory, Prince of Wales Clinical School University of New South Wales, Sydney, Australia
| | - Paul Henri Bauwens
- Department of pediatric Orthopaedic Surgery, Lyon University Hospital for Mother and Children, Bron
| | - Jeanne Commeureuc
- Department of pediatric Orthopaedic Surgery, Lyon University Hospital for Mother and Children, Bron
| | - Simon Vandergugten
- Pediatric Orthopaedic Surgery Unit, Cliniques Universitaires UCL Saint-Luc Bruxelles, Grand Hopital de Charleroi, Charleroi, Belgium
| | - Franck Chotel
- Department of pediatric Orthopaedic Surgery, Lyon University Hospital for Mother and Children, Bron
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Rublev GA, Natchkebia L, Gaprindashvili V, Mohamed MA, Tamazishvili T, Kartozia I, Zimlitski M. Arthroscopic Saucerization of Discoid Lateral Meniscus, With Meniscus Repair as Indicated, Results in Excellent Outcomes in Pediatric Patients Younger Than 12 Years of Age. Arthrosc Sports Med Rehabil 2024; 6:100915. [PMID: 38532769 PMCID: PMC10963204 DOI: 10.1016/j.asmr.2024.100915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 02/16/2024] [Indexed: 03/28/2024] Open
Abstract
Purpose To evaluate the experiences and outcomes of arthroscopic partial meniscectomy in symptomatic non-Wrisberg discoid lateral meniscus in children younger than 12 years old at a single center. Methods We retrospectively reviewed the medical records of all pediatric patients who were treated for non-Wrisberg discoid meniscus at our institute between 2013 and 2021. Patients were separated into 2 groups: Patients who underwent partial resection with saucerization (group A) or patients who underwent saucerization, tear repair, and fixation (group B). Clinical outcomes were compared between the 2 groups. Results A total of 20 patients (22 knees) were treated for non-Wrisberg discoid meniscus and included in this study. Nine patients underwent partial resection with saucerization (group A) whereas 11 patients underwent saucerization, tear repair, and fixation (group B). The average follow-up was 3 years (range 2-10 years). The results showed that 17 of the 20 patients had excellent outcomes whereas the other 3 had good outcomes after a minimum follow-up of 2 years. The average Knee Injury and Osteoarthritis Outcome Score for Children score was 93. Conclusions Arthroscopic saucerization of symptomatic non-Wrisberg discoid lateral meniscus, with additional repair as indicated results in excellent or good outcomes in children younger than 12 years of age. Level of Evidence Level III, case-control study.
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Affiliation(s)
- George A. Rublev
- Center for Arthrology, Sports Medicine, and Regenerative PRP at MediClub, Tbilisi, Georgia
- AIETI David Tvildiani Medical University, Tbilisi, Georgia
| | - Levan Natchkebia
- Center for Arthrology, Sports Medicine, and Regenerative PRP at MediClub, Tbilisi, Georgia
| | - Vazha Gaprindashvili
- Center for Arthrology, Sports Medicine, and Regenerative PRP at MediClub, Tbilisi, Georgia
| | | | - Tamaz Tamazishvili
- Center for Arthrology, Sports Medicine, and Regenerative PRP at MediClub, Tbilisi, Georgia
| | - Irakli Kartozia
- Center for Arthrology, Sports Medicine, and Regenerative PRP at MediClub, Tbilisi, Georgia
| | - Mikheil Zimlitski
- Center for Arthrology, Sports Medicine, and Regenerative PRP at MediClub, Tbilisi, Georgia
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Talathi N, Bennett A, Chiou D, Beck J. Patient-Reported Outcomes After Surgically Treated Anterior Horn Tears in the Pediatric Discoid Meniscus. Orthop J Sports Med 2024; 12:23259671241232308. [PMID: 38571486 PMCID: PMC10989054 DOI: 10.1177/23259671241232308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 08/21/2023] [Indexed: 04/05/2024] Open
Abstract
Background As a subset of symptomatic discoid lateral meniscal (DLM) tears, anterior horn (AH) meniscal tears are not well studied in the pediatric population. There are even fewer studies reporting patient-reported outcomes after surgical treatment of AH tears in DLM. Purpose To compare reported outcomes after surgical treatment of DLM tears involving the AH versus other locations in pediatric patients. Study Design Cohort study; Level of evidence, 3. Methods A retrospective review of prospectively collected patient data between 2013 and 2020 was conducted. Patients aged <18 years who underwent arthroscopic treatment of a symptomatic DLM were included. Pathology was classified as tears of the AH or tears not involving the anterior horn (NAH). Demographic data along with patient-reported outcome scores (Pediatric International Knee Documentation Committee [Pedi-IKDC] and Patient Assessment Questionnaire [PAQ]) were collected preoperatively through 24 months of follow-up. Results A total of 41 patients were included (median age, 12.9 years; range, 7-17 years; 32% female, 68% male). The mean follow-up time for was 25 months (range, 8-58 months). There were 17 (41%) patients in the AH group and 24 (59%) patients in the NAH group. Of the AH group, 16 (94%) were treated with meniscal repair (vs menisectomy), while 19 (79%) of the NAH group were treated with meniscal repair. All patients achieved significant pre- to postoperative improvement on both the Pedi-IKDC and the PAQ. At 24-month follow-up, there were no differences between the AH and NAH groups on the Pedi-IKDC (92.51 vs 89.72; P = .18) or the PAQ (2.57 vs 2.61; P = .06). Conclusion Patients who underwent meniscal repair for AH DLM reported positive postoperative outcomes.
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Affiliation(s)
- Nakul Talathi
- Department of Orthopaedic Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA
| | - Abbie Bennett
- Department of Orthopaedic Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA
| | - Daniel Chiou
- Department of Orthopaedic Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA
| | - Jennifer Beck
- Department of Orthopaedic Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA
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Cho JH, Nam HS, Park SY, Ho JPY, Lee YS. Arthroscopic Meniscal Repair and Meniscectomy for Adult Discoid Lateral Meniscus Results in Progression to Valgus Alignment and Lateral Compartment Degeneration Compared With Nonoperative Treatment and Nondiscoid Lateral Meniscus. Arthroscopy 2024; 40:1223-1233. [PMID: 37717929 DOI: 10.1016/j.arthro.2023.08.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 09/19/2023]
Abstract
PURPOSE To analyze the effect of the arthroscopic meniscal procedure in adult discoid lateral meniscus (DLM) according to the age and meniscal-preserving by making comparisons with the nondiscoid lateral meniscus (N-DLM). METHODS From March 2014 to October 2020, a comparative analysis was performed in adults with DLM who underwent arthroscopic meniscal procedures (operative DLM: 134 knees), nonoperative treatment (nonoperative DLM: 56 knees), and adult N-DLM who underwent arthroscopic meniscal procedures (operative N-DLM: 64 knees). These patients were between 20 and 65 years old and completed a minimum follow-up of 2 years. Patients with DLM who underwent arthroscopic procedure were divided into subgroups according to age and extent of the meniscal-preserving. The following parameters were assessed and compared between the groups: (1) coronal limb alignment, (2) osteoarthritis grade, and (3) clinical outcomes and the minimal clinically important difference. RESULTS The coronal limb alignment was significantly changed to valgus in the order of operative DLM, N-DLM, and nonoperative DLM (Δ mechanical hip-knee-ankle angle: 3.23 ± 1.85 vs 1.35 ± 1.03° vs -0.57 ± 1.88°; P < .05). Operative DLM showed most prominent osteoarthritic change in the lateral compartment, followed by the N-DLM and nonoperative DLM groups (40.3% vs 17.2% vs 5.3%; P < .05). These changes in operative DLM were more prominent in older adults who underwent meniscal-sacrificing procedures and resulted in less-satisfactory clinical outcomes (all P < .05). CONCLUSIONS Arthroscopic surgery for adult DLM resulted in progression to valgus alignment and lateral compartment degeneration compared with nonoperative treatment and arthroscopic surgery of the adult N-DLM. Old ager and having a meniscal-sacrificing procedure showed more rapid radiographic changes and lower clinical outcomes. LEVEL OF EVIDENCE Level III, retrospective comparison study.
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Affiliation(s)
- Joon Hee Cho
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | - Hee Seung Nam
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | - Seong Yun Park
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | - Jade Pei Yuik Ho
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | - Yong Seuk Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea.
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Ducrot C, Piffoux M, Josse A, Raux S, Chotel F. Arthroscopic Suture-Saucerization of Discoid Meniscus Allows Volume Conservation but Does Not Fully Restore Coverage. Arthrosc Sports Med Rehabil 2023; 5:100803. [PMID: 37780937 PMCID: PMC10539866 DOI: 10.1016/j.asmr.2023.100803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/29/2023] [Indexed: 10/03/2023] Open
Abstract
Purpose The purpose of this study was to quantify the effect of meniscoplasty suture-saucerization on volume and surface coverage of lateral discoid menisci. Methods This retrospective study included all consecutive 10 patients treated between 2014 and 2019 who had magnetic resonance imaging before and after surgery and 15 controls. The MITK 3M3 semiautomatic software was used to segment the meniscus and cartilage before and after surgery to measure the percentage of meniscus coverage on the tibial cartilage. Results are compared to control patients without knee pathology matched on sex and age with Student t test. Results Discoid meniscus surface and volume before surgery were respectively 597 mm2 (range, 550-887 mm2) and 2,822 mm³ (1,571-3,407 mm³), representing 74.5% (56%-89%) of the tibial cartilage surface. After surgery, it decreased to 422 mm2 (229-569 mm2) and 1,235 mm³ (680-1,738 mm³), leading to 45.7% (22.5%-68.6%) coverage. In the control group, median surface was 457 mm2 (314-641 mm2), volume was 1,321 mm3 (641-2,240 mm3), and tibial coverage was 55% (41%-77%). Altogether, meniscus volume after surgery was similar to normal, while coverage was significantly lower than controls (P = .04). Conclusions Meniscoplasty suture-saucerization procedure may allow meniscus sparing and restauration of a similar to normal meniscus volume. Meniscus surface and coverage are diminished compared to controls. Both surface and volume normalization is usually not achievable without decreasing the thickness of the rather thick discoid meniscus. Clinical Relevance Both surface and volume normalization is usually not achievable without decreasing the thickness of thick discoid menisci.
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Affiliation(s)
- Colione Ducrot
- Department of Pediatric Orthopedic Surgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
- Team Cell Death and Pediatric Cancer, Cancer Initiation and Tumor Cell Identity Department, INSERM1052, CNRS5286, Cancer Research Center of Lyon, Lyon, France
| | - Max Piffoux
- Medical Oncology, Centre Léon Bérard, Lyon, France
- Medical Oncology, Hospices Civils de Lyon, Pierre-bénite, France
- Laboratoire matière et systèmes complexes (MSC), Université de Paris, CNRS UMR7057, Paris, France
| | - Antoine Josse
- Department of Pediatric Orthopedic Surgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - Sebastien Raux
- Department of Pediatric Orthopedic Surgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
- Hôpital Nord-Ouest-Villefranche sur Saône, Gleizé, France
| | - Franck Chotel
- Department of Pediatric Orthopedic Surgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
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Nishino K, Hashimoto Y, Kinoshita T, Iida K, Tsumoto S, Nakamura H. Comparative analysis of discoid lateral meniscus size: a distinction between symptomatic and asymptomatic cases. Knee Surg Sports Traumatol Arthrosc 2023; 31:5783-5790. [PMID: 37934284 DOI: 10.1007/s00167-023-07650-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/24/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE This study evaluated the differences in meniscal sizes and occupancy between symptomatic and asymptomatic patients diagnosed with discoid lateral meniscus (DLM) using magnetic resonance imaging (MRI) to understand how these variations relate to the presence of symptoms and the patients' age. METHODS A retrospective review of 98 patients with DLM was conducted, excluding those with meniscal displacement. Both the width and extrusion of DLM and the percentage of the meniscus to the tibia were measured using mid-coronal and mid-sagittal MRI and compared between symptomatic and asymptomatic DLM groups. The relationships among each parameter, meniscal size, and patient age were evaluated. Symptomatic cases were divided into those with and without horizontal tears on MRI to compare the differences in meniscal morphology. RESULTS A total of 92 knees from 74 patients were included. Sixty-one knees required surgical intervention for symptomatic DLM, while 31 were asymptomatic and included the contralateral side of symptomatic knees. The symptomatic group exhibited larger morphological variations than the asymptomatic group. Moreover, the sagittal meniscal ratio reduced with age in the asymptomatic group (r = - 0.54, p = 0.002) but remained constant in the symptomatic group. The symptomatic cases with horizontal tears demonstrated larger meniscal dimensions and smaller posterior capsule distances than those without tears. CONCLUSION Symptomatic patients with DLM had larger knee morphological changes than asymptomatic ones. Age affected the meniscal occupancy in the sagittal plane only in asymptomatic patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Kazuya Nishino
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Yusuke Hashimoto
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Takuya Kinoshita
- Department of Orthopaedic Surgery, Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Ken Iida
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Shuko Tsumoto
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-ku, Osaka, 545-8585, Japan
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Kinoshita T, Hashimoto Y, Nishino K, Iida K, Nakamura H. Saucerization of complete discoid lateral meniscus is associated with change of morphology of the lateral femoral condyle and tibial plateau. Arch Orthop Trauma Surg 2023; 143:7019-7026. [PMID: 37522940 DOI: 10.1007/s00402-023-04999-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 07/18/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE To determine the effect of saucerization surgery on knee joint morphology associated with a complete discoid lateral meniscus (DLM) using magnetic resonance (MR) imaging. METHODS This retrospective study included cases had undergone saucerization surgery for symptomatic DLM between 2007 and 2022. All cases were divided into two by age group: < 12 (U13) and > 13 (O13). The cases in the match group were randomly selected from preoperative cases in the O13 group matched with the age at the final follow-up (F/U) of cases in the U13 group. The following morphological parameters were evaluated using MR images preoperatively and at the final postoperative F/U in each group: anterior obliquity of the lateral tibial plateau (AOLTP), posterior obliquity of the lateral tibial plateau (POLTP), and the lowest point of the lateral femoral condyle (LPLFC). Each parameter was compared between the U13 preoperative (pre-OP) group and the O13 pre-OP group, the preoperative and final follow-up in the U13, and the U13 group at the final F/U and the match group preoperatively. RESULTS A total of 77 cases were evaluated. 31 cases were in the U13 pre-OP group and 46 were in the O13 pre-OP group. With a minimal F/U of 2 years, 27 cases in the U13 group and 36 in the O13 group were included. The mean F/U period was 4.6 years in the U13 group and 3.2 years in the O13 group. 32 cases were included in the match group. In the match group, the inclination of the POLTP was significantly larger (P = 0.042) and the LPLFC was more lateral (P = 0.0034) than at the final F/U in the U13 group. CONCLUSIONS Saucerization surgery for DLM in juvenile patients can prevent progression to the characteristic bone morphology DLM. These results could help the surgeon making the decision when the surgery would be performed for symptomatic DLM patients. LEVEL OF EVIDENCE Retrospective comparative study; level of evidence, 3.
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Affiliation(s)
- Takuya Kinoshita
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yusuke Hashimoto
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Kazuya Nishino
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Ken Iida
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
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Adsit E, Albright J, Algan S, Beck J, Bowen RE, Brey J, Marc Cardelia J, Clark C, Coello P, Crepeau A, Edmonds E, Ellington M, Ellis HB, Fabricant PD, Frank JS, Ganley TJ, Green DW, Gupta A, Heyworth B, Kemper WC, Latz K, Mansour A, Mayer S, McKay SD, Milewski MD, Niu E, Pacicca DM, Parikh SN, Pupa L, Rhodes J, Saper M, Schmale GA, Schmitz M, Shea K, Silverstein RS, Storer S, Wilson PL. Relationship Between Age and Pathology With Treatment of Pediatric and Adolescent Discoid Lateral Meniscus: A Report From the SCORE Multicenter Database. Am J Sports Med 2023; 51:3493-3501. [PMID: 37899536 PMCID: PMC10623608 DOI: 10.1177/03635465231206173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 07/20/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Surgical treatment options of discoid lateral meniscus in pediatric patients consist of saucerization with or without meniscal repair, meniscocapular stabilization, and, less often, subtotal meniscectomy. PURPOSE To describe a large, prospectively collected multicenter cohort of discoid menisci undergoing surgical intervention, and further investigate corresponding treatment of discoid menisci. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A multicenter quality improvement registry (16 institutions, 26 surgeons), Sports Cohort Outcomes Registry, was queried. Patient characteristics, discoid type, presence and type of intrasubstance meniscal tear, peripheral rim instability, repair technique, and partial meniscectomy/debridement beyond saucerization were reviewed. Discoid meniscus characteristics were compared between age groups (<14 and >14 years old), based on receiver operating characteristic curve, and discoid morphology (complete and incomplete). RESULTS In total, 274 patients were identified (mean age, 12.4 years; range, 3-18 years), of whom 55.6% had complete discoid. Meniscal repairs were performed in 55.1% of patients. Overall, 48.5% of patients had rim instability and 36.8% had >1 location of peripheral rim instability. Of the patients, 21.5% underwent meniscal debridement beyond saucerization, with 8.4% undergoing a subtotal meniscectomy. Patients <14 years of age were more likely to have a complete discoid meniscus (P < .001), peripheral rim instability (P = .005), and longitudinal tears (P = .015) and require a meniscal repair (P < .001). Patients ≥14 years of age were more likely to have a radial/oblique tear (P = .015) and require additional debridement beyond the physiologic rim (P = .003). Overall, 70% of patients <14 years of age were found to have a complete discoid meniscus necessitating saucerization, and >50% in this young age group required peripheral stabilization/repair. CONCLUSION To preserve physiological "normal" meniscus, a repair may be indicated in >50% of patients <14 years of age but occurred in <50% of those >14 years. Additional resection beyond the physiological rim may be needed in 15% of younger patients and 30% of those aged >14 years.
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Affiliation(s)
| | | | - Jay Albright
- Department of Orthopedics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Sheila Algan
- Department of Orthopedic Surgery, Oklahoma Children's Hospital, Oklahoma City, Oklahoma, USA
| | | | - Richard E. Bowen
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA; Orthopedic Institute for Children's Center for Sports Medicine, Los Angeles, California, USA
| | - Jennifer Brey
- Department of Orthopedics, Norton Children's Orthopedics of Louisville, Louisville, Kentucky, USA
| | - J. Marc Cardelia
- Department of Orthopedics and Sports Medicine, Children's Hospital of the King's Daughters, Norfolk, Virginia, USA
| | - Christian Clark
- OrthoCarolina Pediatric Orthopaedic Center, Charlotte, North Carolina, USA)
| | | | - Allison Crepeau
- Elite Sports Medicine at Connecticut Children's, Hartford, Connecticut, USA; Division of Sports Medicine, Department of Orthopedics, UConn Health, Farmington, Connecticut, USA
| | - Eric Edmonds
- Division of Orthopaedic Surgery, Rady Children's Hospital, San Diego, California, USA
| | - Matthew Ellington
- Department of Orthopedics, Central Texas Pediatric Orthopedics, Austin, Texas, USA; Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Henry B. Ellis
- Investigation performed at Scottish Rite for Children, University of Texas Southwestern Medical Center, Dallas, USA
| | - Peter D. Fabricant
- Division of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA; Weill Cornell Medical College, New York, New York
| | - Jeremy S. Frank
- Division of Pediatric Orthopaedics and Spinal Deformities, Joe DiMaggio Children's Hospital, Hollywood, Florida, USA
| | - Theodore J. Ganley
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Daniel W. Green
- Division of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Andrew Gupta
- Division of Pediatric Orthopaedics and Spinal Deformities, Joe DiMaggio Children's Hospital, Hollywood, Florida, USA
| | - Benton Heyworth
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - W. Craig Kemper
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kevin Latz
- Department of Orthopedics-Sports Medicine, Children's Mercy, Kansas City, Missouri, USA
| | - Alfred Mansour
- Department of Orthopedic Surgery, UTHealth Houston, McGovern Medical School, Houston, Texas, USA
| | - Stephanie Mayer
- Department of Orthopedics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Scott D. McKay
- Baylor College of Medicine, Houston, Texas, USA; Texas Children's Hospital, Houston, Texas, USA
| | - Matthew D. Milewski
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Emily Niu
- Department of Orthopedic Surgery and Sports Medicine, Children's National Medical Center, Washington, DC, USA
| | - Donna M. Pacicca
- Department of Orthopedics-Sports Medicine, Children's Mercy, Kansas City, Missouri, USA
| | - Shital N. Parikh
- Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lauren Pupa
- Baylor College of Medicine, Houston, Texas, USA
| | - Jason Rhodes
- Department of Orthopedics, Children's Hospital Colorado, Aurora, Colorado, USA
| | | | - Gregory A. Schmale
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Matthew Schmitz
- San Antonio Military Medical Center, San Antonio, Texas, USA
| | - Kevin Shea
- Department of Orthopaedics, Stanford University School of Medicine, Stanford, California, USA
| | - Rachel S. Silverstein
- Baylor College of Medicine, Houston, Texas, USA; Texas Children's Hospital, Houston, Texas, USA
| | - Stephen Storer
- Division of Pediatric Orthopaedics and Spinal Deformities, Joe DiMaggio Children's Hospital, Hollywood, Florida, USA
| | - Philip L. Wilson
- University of Texas Southwestern Medical Center, Dallas, Texas, USA; Scottish Rite for Children, Dallas, Texas, USA)
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10
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Simon V, Paul Henri B, Charles F, Hélène B, Nicolas C, Sebastien R, Franck C. Discoid lateral meniscus instability in children: part I. A new grading system of instability to clarify natural history. Knee Surg Sports Traumatol Arthrosc 2023; 31:4809-4815. [PMID: 37563431 DOI: 10.1007/s00167-023-07521-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/24/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE In young patients, the discoid lateral meniscus (DLM) usually becomes symptomatic at the time of peripheral rim instability of a complete discoid form. However, little is known about the natural history of meniscal instability. The aim was to detect hidden forms of presentation of instability using the history and clinical mechanical symptoms of instability. METHODS Retrospective study of 114 paediatric knees treated for DLM. A new clinical grading system for instability (stable, locked, snapping, blocked and unblocked knees) was defined and studied in combination with MRI and arthroscopic findings. RESULTS One hundred seven DLMs (94%) showed instability due to edge detachment. Fifteen (13%) knees were stable (grade 0), 2 (2%) were grade 1, 57 (50%) were grade 2, 35 (31%) were grade 3 and 5 (4%) were grade 4. The cause of grade 3 was an extension deficit (26/35) or flexion deficit (9/35). Grade 1 or 2 correlated with limited detachment, unlike grade 3 or 4. The grade of instability never decreased, but rather increased in many knees during the natural history of DLM. CONCLUSION A new presentation of DLM is presented: episodic locking phenomenon and blocked knee with flexion deficit. Clinicians should be wary of pseudo-improvement with the recovery of mobility after a period of the blocked knee, which may be due to a progression towards the ultimate degree of instability. Clinical grading of instability has clarified the natural history of DLM-associated tearing. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Vandergugten Simon
- Pediatric Orthopaedic Surgery Unit, Cliniques Universitaires UCL Saint-Luc Bruxelles, Grand Hopital de Charleroi, Charleroi, Belgium
| | - Bauwens Paul Henri
- Department of pediatric Orthopaedic Surgery, Lyon University Hospital for Mother and Children, 59 Boulevard Pinel, 69677, Bron, France
| | - Fiquet Charles
- Clinique de l'infirmerie Protestante of Lyon, 1-3 chemin du Penthod 69300, Caluire et Cuire, France
| | - Boyer Hélène
- Direction de la Santé, Hospices Civils de Lyon, 3 quai des Célestins, 69002, Lyon, France
| | - Cance Nicolas
- Department of pediatric Orthopaedic Surgery, Lyon University Hospital for Mother and Children, 59 Boulevard Pinel, 69677, Bron, France
| | - Raux Sebastien
- Department of pediatric Orthopaedic Surgery, Lyon University Hospital for Mother and Children, 59 Boulevard Pinel, 69677, Bron, France
| | - Chotel Franck
- Department of pediatric Orthopaedic Surgery, Lyon University Hospital for Mother and Children, 59 Boulevard Pinel, 69677, Bron, France.
- Hospices civils de Lyon, Claude Bernard University Lyon I, Lyon, France.
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11
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Bauwens PH, Vandergugten S, Fiquet C, Raux S, Cance N, Chotel F. Discoid lateral meniscus instability in children: part II.: Repair first to minimise the saucerisation. Knee Surg Sports Traumatol Arthrosc 2023; 31:4816-4823. [PMID: 37659011 DOI: 10.1007/s00167-023-07538-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/01/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE Despite an improved understanding of discoid lateral meniscus (DLM), the treatment of symptomatic discoid lateral meniscus remains controversial. METHODS The aim of this retrospective, single-centred, consecutive-case study was to evaluate the clinical outcome of 60 DLM treated arthroscopically by the "meniscoplasty or saucerisation-suture" technique in children and adolescents [median (range) age 11 (4-17) years], and to investigate surgical failures. The instability was assessed before any saucerisation. The hypotheses were that: (i) the management of instability with suture first was effective and that (ii) a combined classification with clinical and MRI data had a prognostic value. RESULTS In 57 knees (95%), the DLM was unstable, and a suture fixation was performed. After a median follow-up of 41.5 months, the median (range) IKDC score was improved from 55 (10-70) preoperatively to 90 (37.5-100) postoperatively. The median (range) Lysholm score at last follow-up was 93.5 (45-100). The procedure was effective in 49 knees (81.6%) after a single procedure. Eleven patients had a failure with a new meniscal tear after a median (range) delay of 42 months (24-60) after the initial procedure. The patterns of discoid lateral meniscus instability were not found to have a prognostic value for surgical failure since they mainly occurred after sport-related injuries. All the patients with initial repair failures but one achieved a good clinical outcome after revision repair without any further meniscectomy. CONCLUSION In contrast to adult knees, symptomatic discoid lateral meniscus is rarely stable in children (5%). Meniscal repair is effective to preserve the meniscus tissue, but revision repair became necessary in 18% of the cases and was finally successful. Level of evidence Level III.
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Affiliation(s)
- Paul Henri Bauwens
- Department of Pediatric Orthopaedic Surgery, Lyon University Hospital for Mother and Children, 59 Boulevard Pinel, 69677, Bron, France
| | - Simon Vandergugten
- Pediatric Orthopaedic Surgery Unit, Cliniques Universitaires UCL Saint-Luc Bruxelles, and in Grand Hopital de Charleroi, Lyon, France
| | - Charles Fiquet
- Clinique de l'infirmerie Protestante of Lyon, 1-3 Chemin du Penthod, 69300, Caluire et Cuire, France
| | - Sébastien Raux
- Department of Pediatric Orthopaedic Surgery, Lyon University Hospital for Mother and Children, 59 Boulevard Pinel, 69677, Bron, France
| | - Nicolas Cance
- Department of Pediatric Orthopaedic Surgery, Lyon University Hospital for Mother and Children, 59 Boulevard Pinel, 69677, Bron, France
| | - Franck Chotel
- Department of Pediatric Orthopaedic Surgery, Lyon University Hospital for Mother and Children and Claude Bernard University Lyon I., Hospices Civils de Lyon, 59 Boulevard Pinel, 69677, Bron, France.
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12
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Kinoshita T, Hashimoto Y, Iida K, Nakamura H. Evaluation of the knee joint morphology associated with a complete discoid lateral meniscus, as a function of skeletal maturity, using magnetic resonance imaging. Arch Orthop Trauma Surg 2023; 143:2095-2102. [PMID: 35838822 DOI: 10.1007/s00402-022-04538-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 06/28/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION A discoid lateral meniscus (DLM) is associated with increased risk for meniscal tears and progression of knee joint osteoarthritis. Our aim was to differentiate knee joint morphology between patients with and without a DLM, as a function of skeletal maturity, using magnetic (MR) imaging. MATERIALS AND METHODS This was a retrospective analysis of MR images of the knee for 110 patients, 6-49 years of age. Of these, 62 were in the open physis group (38 with a DLM) and 48 in the closed physis group (23 with a DLM). The following morphological parameters were measured: anterior obliquity of the lateral tibial plateau (AOLTP), posterior obliquity of the lateral tibial plateau (POLTP), the lowest point of the lateral femoral condyle (LPLFC), and the posterior lateral condylar angle (PLCA). RESULTS Regardless of skeletal maturity, a DLM was associated with a greater inclination of the POLTP, lateralization of the LPLFC, and smaller PLCA (p < 0.001 for all compared to that of the control group). In the DLM group, the inclination of the AOLTP and the POLTP were significantly smaller (p < 0.001) and the LPLFC was more lateral (p < 0.001) in the closed physis group than in the open physis group. In the control group, the inclination of the POLTP was larger (p < 0.001) and the PLCA smaller (p = 0.019) in the open than in the closed physis group. CONCLUSIONS We identified a characteristic knee morphology among patients with a complete DLM using MR imaging, which was observed before physeal closure and persisted after skeletal maturity was attained. We also noted lateralization of the LPLFC in the presence of a DLM, with an increase in lateralization with skeletal maturation. LEVEL OF EVIDENCE Case-control study, III.
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Affiliation(s)
- Takuya Kinoshita
- Department of Orthopaedic Surgery, Osaka Metropolitan University, Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Yusuke Hashimoto
- Department of Orthopaedic Surgery, Osaka Metropolitan University, Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Ken Iida
- Department of Orthopaedic Surgery, Osaka Metropolitan University, Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka Metropolitan University, Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
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13
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Yokoe T, Ouchi K, Matsumoto T, Tajima T, Chosa E. Effect of the volume of resected discoid lateral meniscus on the contact stress of the tibiofemoral joint: A finite element analysis. Knee 2023; 42:57-63. [PMID: 36905825 DOI: 10.1016/j.knee.2023.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/02/2023] [Accepted: 02/13/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Partial meniscectomy is commonly performed for symptomatic patients with discoid lateral meniscus (DLM) if conservative treatment fails. However, the development of knee osteoarthritis and osteochondral lesion are detrimental postoperative complications. This study aimed to evaluate the effect of the volume of resected DLM on the contact stress of the tibiofemoral joint using a finite element analysis. METHODS Subject-specific finite-element models of the knee joint of a patient with DLM were developed from computed tomographic and magnetic resonance images. To evaluate the effect of partial meniscectomy on the contact stress in the lateral tibiofemoral joint, six knee models were created in the study (the native DLM, and five partially meniscectomized DLMs (according to the preserved width of the meniscus: 12 mm, 10 mm, 8 mm, 6 mm, and 4 mm)). RESULTS As the volume of resected DLM increased, higher contact stress was applied to the lateral tibiofemoral joint. Greater contact stress was applied to the preserved lateral meniscus than to the native DLM. CONCLUSIONS From a biomechanical viewpoint, the native DLM was the most protective against lateral tibiofemoral contact stress in comparison to partially meniscectomized DLMs.
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Affiliation(s)
- Takuji Yokoe
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Koki Ouchi
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
| | - Taisei Matsumoto
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Takuya Tajima
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Etsuo Chosa
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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14
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Anderson KG, Carsen S, Stinson Z, Kushare I, Finlayson CJ, Nault ML, Lee RJ, Haus BM, Schmale GA. Medial Discoid Meniscus in Children: A Multicenter Case Series of Clinical Features and Operative Results. Am J Sports Med 2023; 51:1171-1176. [PMID: 36876853 DOI: 10.1177/03635465231159671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND The discoid medial meniscus is a rare congenital anomaly of the knee. The literature is limited to small case series. PURPOSE/HYPOTHESIS Our purpose is to report the clinical manifestations and operative treatments of discoid medial menisci in children from multiple centers in North America. We hypothesized that symptoms and signs, arthroscopic findings, surgical treatments, and outcomes are similar to those for symptomatic discoid lateral menisci. STUDY DESIGN Case series; Level of evidence, 4. METHODS A retrospective review identified patients with a diagnosed discoid medial meniscus confirmed at surgery across 8 children's hospitals between January 2000 and June 2021. The literature on discoid lateral menisci was reviewed and summarized for comparison. RESULTS A total of 21 patients (9 female, 12 male) with 22 discoid medial menisci were identified. The mean ± SD age at the time of diagnosis was 12.8 ± 3.8 years. The most common symptoms and signs were locking and/or clunking, present in 12 of 22 knees (55%), similar to that reported in patients with discoid lateral menisci. Twelve discoid medial menisci were complete (55%); 8, incomplete (36%); and 2, indeterminate (9%). Tears were present in 13 knees, most commonly horizontal cleavage (54%). Five discoid medial menisci were unstable (23%): 3 for posterior tears and 2 for rim insufficiency. All 22 knees underwent arthroscopic saucerization, and of the 13 torn menisci, 7 (54%) were repaired. The median follow-up was 24 months (range, 2-82 months). Four knees underwent reoperation. All knees that required reoperation had undergone repair for a posteriorly located tear. There was a significant association between operative repair and need for reoperation (P = .0048). High rates of peripheral instability were also noted in case series of patients with discoid lateral menisci. CONCLUSION Patient presentations and treatments for those with discoid medial menisci were similar to those reported for patients with discoid lateral menisci. Knees with discoid medial menisci also demonstrated instability attributed to peripheral insufficiency and posterior tears. Tears were present in over half of knees with discoid medial menisci, and reoperation was more common in knees that underwent repair of tears than those without repair.
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Affiliation(s)
| | - Sasha Carsen
- Children's Hospital of Eastern Ontario, Ottowa, Ontario, Canada
| | - Zachary Stinson
- Nemours Children's Health and University of Central Florida School of Medicine, Orlando, Florida, USA
| | - Indranil Kushare
- Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Craig J Finlayson
- Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - R Jay Lee
- Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Brian M Haus
- University of California Davis Children's Hospital, Sacramento, California, USA
| | | | - Gregory A Schmale
- Seattle Children's and University of Washington School of Medicine, Seattle, Washington, USA
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15
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Arthroscopic surgery for symptomatic discoid lateral meniscus improves meniscal status assessed by magnetic resonance imaging T2 mapping. Arch Orthop Trauma Surg 2023:10.1007/s00402-023-04819-9. [PMID: 36811665 DOI: 10.1007/s00402-023-04819-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 02/13/2023] [Indexed: 02/24/2023]
Abstract
INTRODUCTION Discoid lateral meniscus (DLM) is an anatomic knee variant associated with increased tears and degeneration. This study aimed to quantify meniscal status with magnetic resonance imaging (MRI) T2 mapping before and after arthroscopic reshaping surgery for DLM. MATERIALS AND METHODS We retrospectively reviewed the records of patients undergoing arthroscopic reshaping surgery for symptomatic DLM with ≥ 2-year follow-up. MRI T2 mapping was performed preoperatively and at 12 and 24 months postoperatively. T2 relaxation times of the anterior and posterior horns of both menisci and of the adjacent cartilage were assessed. RESULTS Thirty-six knees from 32 patients were included. The mean age at surgery was 13.7 years (range 7-24), and the mean follow-up duration was 31.0 months. Saucerization alone was performed on five knees and saucerization with repair on 31 knees. Preoperatively, the T2 relaxation time of the anterior horn of the lateral meniscus was significantly longer than that of the medial meniscus (P < 0.01). T2 relaxation time significantly decreased at 12 and 24 months postoperatively (P < 0.01). Assessments of the posterior horn were comparable. The T2 relaxation time was significantly longer in the tear versus non-tear side at each time point (P < 0.01). There were significant correlations between the T2 relaxation time of the meniscus and that of the corresponding area of the lateral femoral condyle cartilage (anterior horn: r = 0.504, P = 0.002; posterior horn: r = 0.365, P = 0.029). CONCLUSIONS The T2 relaxation time of symptomatic DLM was significantly longer than that of the medial meniscus preoperatively, and it decreased 24 months after arthroscopic reshaping surgery. The meniscal T2 relaxation time of the tear side was significantly longer than that of the non-tear side. There were significant correlations between the cartilage and meniscal T2 relaxation times at 24 months after surgery.
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16
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Hanna T, Smith NP, Sherbondy PS. Arthroscopic Saucerization and Repair of a Torn Medial Discoid Meniscus. Arthrosc Tech 2022; 12:e121-e126. [PMID: 36814971 PMCID: PMC9939740 DOI: 10.1016/j.eats.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/16/2022] [Accepted: 09/09/2022] [Indexed: 12/24/2022] Open
Abstract
A discoid meniscus is a congenital abnormality that usually affects the lateral meniscus, leading to instability and increased risk of tearing. A discoid medial meniscus is an extremely rare pathology that is seldom described in literature. In this report, we present the technique of operative treatment of a symptomatic, torn discoid medial meniscus. The meniscus is saucerized to 6-8 mm of stable rim, and the inside-out technique is used as the modality of meniscal fixation. Although a discoid medial meniscus is an uncommon finding, all treating surgeons should be aware of the possibility during surgical intervention.
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Affiliation(s)
- Tammam Hanna
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, The Pennsylvania State University, University Park, Pennsylvania, U.S.A
| | - Nathan P. Smith
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A.,Address correspondence to Nathan P. Smith, B.S., 187 University Manor East, Hershey, PA, 17033, U.S.A.
| | - Paul S. Sherbondy
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, The Pennsylvania State University, University Park, Pennsylvania, U.S.A
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17
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He Y, Chen H, Fan Y, Zhou Y, Bao W. Partial resection of lateral discoid meniscus changes lower limb axial alignment - A retrospective cohort study. Knee 2022; 37:171-179. [PMID: 35809449 DOI: 10.1016/j.knee.2022.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 02/28/2022] [Accepted: 06/20/2022] [Indexed: 02/02/2023]
Abstract
AIM This study aimed to explore the changes in lower limb axial alignment and knee joint function after arthroscopic partial resection of the discoid lateral meniscus. METHODS Preoperative and postoperative full-length weight-bearing radiographs of the lower limb were obtained from a total of 161 patients with lateral menisci tears from September 2018 to September 2020 who underwent partial meniscal resection. The patients were divided into discoid meniscus group (DMG) and ordinary meniscus group (OMG). The measured mechanical axis deviation (MAD), proximal tibia angle (PTA), and distal femoral angle (DFA) in the axial alignment of the lower limb were determined before and after surgery. Knee joint function on the affected side was determined using the International Knee Documentation Committee (IKDC) subjective scale and the Lysholm knee scoring scale before surgery and at one, six, 12, and 24 months after surgery. RESULTS For MAD and DFA, there were statistically significant differences between the preoperative and postoperative findings within each group (P < 0.01); the MAD and DFA were smaller after surgery. The difference in preoperative and postoperative PTA of the DMG was statistically significant (P < 0.01), meaning that the PTA becomes larger after surgery. The differences in preoperative and postoperative PTA of the OMG, preoperative PTA between the two groups, and postoperative PTA between the two groups were not statistically significant (P > 0.05). Intragroup comparisons of the IKDC subjective scale and the Lysholm knee scoring scale before and after surgery revealed significant differences (P < 0.05). CONCLUSION Arthroscopic partial resection of the discoid lateral meniscus is a safe and effective surgical method that can significantly improve knee joint function. Although the axial arrangement of the lower limbs will be slightly changed in the early stage, it will still be within the normal range after surgery in patients with normal lower limb axial alignment. For patients with varus or valgus before surgery, this procedure should be applied with caution.
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Affiliation(s)
- Yao He
- Department of Orthopedics, Banan Hospital of Chongqing Medical University, China
| | - Hong Chen
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, China
| | - Yuanjun Fan
- Department of Orthopedics, Banan Hospital of Chongqing Medical University, China
| | - Yuandong Zhou
- Department of Orthopedics, Banan Hospital of Chongqing Medical University, China
| | - Wei Bao
- Department of Orthopedics, Banan Hospital of Chongqing Medical University, China.
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18
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Nishino K, Hashimoto Y, Iida K, Nishida Y, Yamasaki S, Nakamura H. Association of Postoperative Lateral Meniscal Extrusion With Cartilage Degeneration on Magnetic Resonance Imaging After Discoid Lateral Meniscus Reshaping Surgery. Orthop J Sports Med 2022; 10:23259671221091997. [PMID: 35528992 PMCID: PMC9073126 DOI: 10.1177/23259671221091997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Although arthroscopic reshaping surgery for a discoid lateral meniscus (DLM) has good clinical results, it cannot completely prevent degeneration. The degree of DLM extrusion associated with degenerative changes is unclear. Purpose/Hypothesis: To measure meniscal extrusion preoperatively and postoperatively in patients who underwent DLM-reshaping surgery and examine factors associated with knee articular cartilage degeneration. It was hypothesized that meniscal extrusion existed preoperatively, progressed postoperatively, and was related to knee joint degeneration. Study Design: Case-control study; Level of evidence, 3. Methods: We retrospectively reviewed the medical records of patients who underwent DLM-reshaping surgery and attended ≥2 years of follow-up. Magnetic resonance imaging (MRI) was performed preoperatively and at 24 months postoperatively, and residual midbody meniscal extrusion was measured. Cartilage degeneration was detected when the Whole-Organ Magnetic Resonance Imaging Score (WORMS) of the lateral compartment was grade ≥3 at 2 years postoperatively. Factors associated with MRI cartilage degeneration were evaluated. Results: Included in this study were 48 knees in 39 patients; the mean patient age at the time of surgery was 12.0 years. The mean midbody meniscal extrusion significantly increased from 0.8 mm preoperatively to 1.6 mm at 24 months postoperatively ( P < .001). According to the WORMS cartilage score, 16 patients were categorized as having MRI cartilage degeneration. Multivariate logistic analysis showed that an inferior preoperative Lysholm score (odds ratio, 0.89; P = .024) and postoperative extrusion (odds ratio, 6.18; P = .010) significantly increased the risk of cartilage degeneration. The receiver operating characteristic curve showed that a residual meniscal extrusion of 2.0 mm was the cutoff value indicating cartilage degeneration (sensitivity, 87.5%; specificity, 78.1%). Conclusion: DLM extrusion significantly increased from 0.8 mm preoperatively to 1.6 mm at 2 years postoperatively. Postoperative extrusion and a lower preoperative Lysholm score were factors related to MRI cartilage degeneration postoperatively. A postoperative extrusion of 2.0 mm was the cutoff value for MRI cartilage degeneration.
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Affiliation(s)
- Kazuya Nishino
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yusuke Hashimoto
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Ken Iida
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yohei Nishida
- Department of Orthopaedic Surgery, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Shinya Yamasaki
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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19
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Symptomatic discoid lateral meniscus shows a relationship between types and tear patterns, and between causes of clinical symptom onset and the age distribution. Knee Surg Sports Traumatol Arthrosc 2022; 30:1436-1442. [PMID: 34110457 DOI: 10.1007/s00167-021-06635-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 06/08/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Discoid meniscus is a congenital abnormality of the lateral meniscus and is seen more frequently in East Asia. The purpose of this study was to retrospectively assess the relationship between discoid lateral meniscus (DLM) types and tear patterns and causes of age-specific clinical symptom onset. METHODS Of 1650 arthroscopic surgeries over a 20-year period, 138 (105 patients) were performed for DLM and were evaluated in this study. The mean age at surgery was 21.5 ± 15.8 years. The DLM type was classified by Watanabe's classification, and tear patterns were classified by the modified Bin's classification as simple horizontal, complicated horizontal, longitudinal, radial, complex, and no tear. Additionally, patients were divided by age group (< 10, 10-19, 20-39, 40-59, and ≥ 60 years) and classified according to the causes of clinical symptom onset as follows: sports activities, minor trauma in daily living, and no traumatic episode. RESULTS The DLM was complete in 78 (56.5%) knees and incomplete in 60 (43.5%); no Wrisberg type DLM was observed. Simple horizontal and complicated horizontal tears were significantly more frequent in complete DLM, whereas radial tears and no tears were significantly more frequent in incomplete DLM (p < 0.0001). When classified by age group, 74 (53.6%) knees with DLMs were found in teenagers. Sports activities caused symptom onset significantly more often in teenagers, no traumatic episode caused symptom onset in patients aged < 10 years, and minor trauma in daily living caused symptom onset in patients aged 40-59 years and ≥ 60 years (p < 0.0001). No relationship was found between the age distribution and tear patterns; however, the absence of tears tended to be more common in teenaged patients, and complicated horizontal tears were more common in patients over 20 years of age. CONCLUSION Symptomatic DLM occurred most often in teenagers. A relationship was identified between the DLM types and tear patterns, which could be helpful in preoperative planning. Causes of clinical symptom onset in patients with DLM were characterised by age group, which might help clinicians to suspect the presence of DLM. LEVEL OF EVIDENCE Level IV.
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Lee RJ, Nepple JJ, Schmale GA, Niu EL, Beck JJ, Milewski MD, Finlayson CJ, Joughin VE, Stinson ZS, Pace JL, Albright J, Carsen S, Chambers H, Nault ML, Schlechter JA, Stavinoha TJ, Tompkins M, Wilson PL, Heyworth BE. Reliability of a New Arthroscopic Discoid Lateral Meniscus Classification System: A Multicenter Video Analysis. Am J Sports Med 2022; 50:1245-1253. [PMID: 35234542 DOI: 10.1177/03635465221076857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The discoid lateral meniscus (DLM) is one of the most common congenital anomalies of the knee. The pathomorphology of DLM varies. Current classification systems are inadequate to describe the spectrum of abnormality. PURPOSE A study group of pediatric orthopaedic surgeons from 20 academic North American institutions developed and tested the reliability of a new DLM classification system. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 3. METHODS After reviewing existing classifications, we developed a comprehensive DLM classification system. Four DLM features were evaluated: meniscal width, meniscal height, peripheral stability, and meniscal tear. Stepwise arthroscopic examination using anteromedial and anterolateral viewing portals was established for evaluating these features. Three senior authors who were not observers selected 50 of 119 submitted videos with the best clarity and stepwise examination for reading. Five observers performed assessments using the new classification system to assess interobserver reliability, and a second reading was performed by 3 of the 5 observers to assess intraobserver reliability using the Fleiss κ coefficient (fair, 0.21-0.40; moderate, 0.41-0.60; substantial, 0.61-0.80; excellent, 0.81-1.00). RESULTS Interobserver reliability was substantial for most rating factors: meniscal width, meniscal height, peripheral stability, tear presence, and tear type. Interobserver reliability was moderate for tear location. Intraobserver reliability was substantial for meniscal width and meniscal height and excellent for peripheral stability. Intraobserver agreement was moderate for tear presence, type, and location. CONCLUSION This new arthroscopic DLM classification system demonstrated moderate to substantial agreement in most diagnostic categories analyzed.
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Affiliation(s)
- R Jay Lee
- Investigation performed at Seattle Children's Hospital, Seattle, Washington, USA
| | - Jeffrey J Nepple
- Investigation performed at Seattle Children's Hospital, Seattle, Washington, USA
| | - Gregory A Schmale
- Investigation performed at Seattle Children's Hospital, Seattle, Washington, USA
| | - Emily L Niu
- Investigation performed at Seattle Children's Hospital, Seattle, Washington, USA
| | - Jennifer J Beck
- Investigation performed at Seattle Children's Hospital, Seattle, Washington, USA
| | - Matthew D Milewski
- Investigation performed at Seattle Children's Hospital, Seattle, Washington, USA
| | - Craig J Finlayson
- Investigation performed at Seattle Children's Hospital, Seattle, Washington, USA
| | - V Elaine Joughin
- Investigation performed at Seattle Children's Hospital, Seattle, Washington, USA
| | - Zachary S Stinson
- Investigation performed at Seattle Children's Hospital, Seattle, Washington, USA
| | - J Lee Pace
- Investigation performed at Seattle Children's Hospital, Seattle, Washington, USA
| | - Jay Albright
- Investigation performed at Seattle Children's Hospital, Seattle, Washington, USA
| | - Sasha Carsen
- Investigation performed at Seattle Children's Hospital, Seattle, Washington, USA
| | - Hank Chambers
- Investigation performed at Seattle Children's Hospital, Seattle, Washington, USA
| | - Marie-Lyne Nault
- Investigation performed at Seattle Children's Hospital, Seattle, Washington, USA
| | - John A Schlechter
- Investigation performed at Seattle Children's Hospital, Seattle, Washington, USA
| | - Tyler J Stavinoha
- Investigation performed at Seattle Children's Hospital, Seattle, Washington, USA
| | - Marc Tompkins
- Investigation performed at Seattle Children's Hospital, Seattle, Washington, USA
| | - Philip L Wilson
- Investigation performed at Seattle Children's Hospital, Seattle, Washington, USA
| | - Benton E Heyworth
- Investigation performed at Seattle Children's Hospital, Seattle, Washington, USA
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Vinagre G, Cruz F, Alkhelaifi K, D'Hooghe P. Isolated meniscus injuries in skeletally immature children and adolescents: state of the art. J ISAKOS 2022; 7:19-26. [PMID: 35543655 DOI: 10.1136/jisakos-2020-000496] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/28/2020] [Accepted: 12/22/2020] [Indexed: 12/18/2022]
Abstract
The prevalence of isolated meniscal injuries in children and adolescents is low; however, we see an increase mainly due to intensified sports-related activities at an early age. A meniscal repair should be attempted whenever possible as children present with increased meniscal healing potential. The diagnosis and management of meniscal tears involve both patient factors and tear characteristics: size, anatomical location and associated injuries. Special attention should be given to the feature of discoid menisci and related tears as they require a specific management plan. This state-of-the-art review highlights the most recent studies on clinical evaluation, surgical techniques, tips and tricks, pitfalls, outcomes, return-to-sports, geographical differences and future perspectives related to meniscal injuries in children and adolescents.
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Affiliation(s)
- Gustavo Vinagre
- Department of Orthopaedic Surgery and Traumatology, Hospital de Verín, Verín, Galicia, Spain. https://twitter.com/DrGVinagre
| | - Flávio Cruz
- Department of Orthopaedic Surgery, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Khalid Alkhelaifi
- Department of Orthopaedic Surgery, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar. https://twitter.com/Alkhelaifi
| | - Pieter D'Hooghe
- Department of Orthopaedic Surgery, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
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22
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Gamble JG, Abdalla AB, Meadows MG, Rauer T, Chan CM, Ganley TJ, Tompkins M, Shea KG, Gamble JG. Radial Width of the Lateral Meniscus at the Popliteal Hiatus: Relevance to Saucerization of Discoid Lateral Menisci. Am J Sports Med 2022; 50:138-141. [PMID: 34780308 DOI: 10.1177/03635465211056661] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A discoid lateral meniscus (DLM) is a congenital anomaly of the knee in which the lateral meniscus has an "O" shape and contains irregular, abnormal collagenous tissue. A DLM can cause mechanical symptoms and pain. Treatment of a symptomatic DLM is arthroscopic saucerization to reshape the meniscus to a more normal contour. Enough tissue must be removed to eliminate mechanical symptoms but not too much to create instability. The residual width of the meniscus is crucial at the popliteus hiatus because here the peripheral rim is unattached at the capsule. Reports in the literature recommend a residual width of 6 to 8 mm. PURPOSE/HYPOTHESIS The purpose of this research was to determine the width of the lateral meniscus at the popliteal hiatus in normal specimens. Our null hypothesis was that a residual width of 6 to 8 mm will be sufficient to approximate normal anatomy. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS We made direct measurements of the radial width of the lateral meniscus from the outer rim at the popliteal hiatus to the inner edge in 19 specimens (age, 2-120 months.) We measured one 4-year-old specimen with a bilateral complete DLM. We also measured 39 digital images of specimens (age, 1-132 months) using ImageJ. Finally, we made direct arthroscopic measurements of 8 skeletally mature specimens. RESULTS The average width of specimens <3 years old was 5.5 mm. The average width of the 10-year-old specimens was 12 mm. The average width of the skeletally mature specimens was 16 mm. A 4-year-old DLM specimen measured 19 mm. CONCLUSION We rejected our null hypothesis. Direct measurements suggest that a residual width of 6 to 8 mm is insufficient for children ≥8 years old. A width of at least a full centimeter approximates the normal for 8-year-olds and at least 15 mm for adolescents.
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Affiliation(s)
- Jamison G Gamble
- School of Medicine, St George's University, Grenada, West Indies
| | | | - Molly G Meadows
- Packard Children's Health, School of Medicine, Stanford University, Stanford, CA, USA
| | - Thomas Rauer
- Department of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Charles M Chan
- Packard Children's Health, School of Medicine, Stanford University, Stanford, CA, USA
| | | | - Marc Tompkins
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kevin G Shea
- Packard Children's Health, School of Medicine, Stanford University, Stanford, CA, USA
| | - James G Gamble
- Packard Children's Health, School of Medicine, Stanford University, Stanford, CA, USA
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23
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Kawashima F, Takagi H. Examination of refractory discoid lateral meniscus injury. J Orthop Surg (Hong Kong) 2021; 29:23094990211022043. [PMID: 34105406 DOI: 10.1177/23094990211022043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Lateral discoid meniscus (LDM) should be treated and preserved with saucerization and/or suture repair. However, repair of the meniscal hoop structure is sometimes difficult due to displacement or large defects. In this study, we aimed to examine tear patterns based on the Ahn classification in those requiring meniscal repair and those undergoing subtotal meniscectomy. METHODS Twenty-three patients were evaluated (mean age, 27.4 years; mean follow-up period, 2.5 years). The following were evaluated: displacement morphology based on the Ahn classification, site of tear under arthroscopy, morphology, surgical procedure, Lysholm score at final postoperative follow-up, and clinical outcome of meniscus using Barrett's criteria. RESULT There were 16 knees without displacement (saucerization with suture repair, 13 knees; subtotal meniscectomy, 3 knees) and 10 knees with displacement (reduction with suture repair, 3 knees; subtotal meniscectomy, 7 knees). Subtotal meniscectomy was performed more often in cases with dislocation, especially in the central shift type as defined by the Ahn classification. The mean Lysholm score was 65.0 points preoperatively and 95.3 points postoperatively. Twenty-three knees (88%) were postoperatively categorized under the Barrett's criteria as healing and 3 knees (12%) were categorized as non-healing. The number of non-healing cases that underwent subtotal meniscectomy was relatively small (1 of 10 knees), and the short-term results were not poor. CONCLUSION Localized peripheral longitudinal tears tended to be repairable even with displacement, while peripheral tears covering the entire meniscus or with severe defects/tears in the body of the meniscus tended to be difficult to repair, leading to subtotal meniscectomy.
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Affiliation(s)
- Fumiyoshi Kawashima
- Department of Orthopedic Surgery, Fujigaoka Hospital, Showa University, Yokohama, Kanagawa, Japan
| | - Hiroshi Takagi
- Department of Orthopedic Surgery, Fujigaoka Hospital, Showa University, Yokohama, Kanagawa, Japan
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24
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Nishino K, Hashimoto Y, Tsumoto S, Yamasaki S, Nakamura H. Morphological Changes in the Residual Meniscus After Reshaping Surgery for a Discoid Lateral Meniscus. Am J Sports Med 2021; 49:3270-3278. [PMID: 34415178 DOI: 10.1177/03635465211033586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic reshaping surgery is the first treatment option for a symptomatic discoid lateral meniscus (DLM) to preserve the peripheral rim. However, the degree of postoperative morphological change in the residual meniscus is unclear. PURPOSE/HYPOTHESIS The purpose of this study was to measure the meniscus after reshaping surgery for a DLM, to verify when the morphological change occurred, and to examine the related risk factors. The hypothesis was that the residual meniscal width would decrease throughout the postoperative course. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS We retrospectively reviewed the medical records of patients who underwent reshaping surgery for a symptomatic DLM and had undergone follow-up for ≥2 years. Magnetic resonance imaging (MRI) was routinely performed preoperatively and at 3, 6, 12, and 24 months postoperatively, and the width, height, and extrusion of the residual meniscus were measured. According to the width of the midbody on final MRI scans, we compared the preoperative and postoperative data for the preserved group (≥5 mm) and decreased group (<5 mm). The associated risk factors for a decreased meniscal width (<5 mm) of the midbody were analyzed on final MRI scans. RESULTS We included 61 knees of 54 patients in this study. The mean age at the time of surgery was 11.7 years. The intraobserver and interobserver reliabilities of the midbody width were 0.937 and 0.921, respectively. The width of the anterior horn, midbody, and posterior horn decreased significantly from 3 to 24 months after surgery (from 9.1 to 8.6 mm [P < .001], from 7.5 to 6.1 mm [P < .001], and from 9.5 to 8.9 mm [P = .001], respectively). Meniscal extrusion of the midbody did not change significantly (from 1.2 to 1.5 mm; P = .062). Overall, 46 knees (n = 20/32 in the preserved group and n = 26/29 in the decreased group) had longitudinal tears that required meniscal repair. Clinical outcomes did not differ significantly between the 2 groups. Multivariate logistic analysis showed that intrameniscal degeneration (odds ratio, 4.36; P = .023) significantly increased the risk of a decreased meniscal width. CONCLUSION The width of the anterior horn, midbody, and posterior horn decreased significantly from 3 to 24 months after surgery. In particular, the average decrease rate of the midbody was 19%. No clinical difference was seen in patients with a decreased width and height or with peripheral extrusion. Increased intrameniscal signals on preoperative MRI scans were associated with an increased risk of a decreased meniscal width. Surgeons should consider this result to determine the amount of resection.
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Affiliation(s)
- Kazuya Nishino
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Yusuke Hashimoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Syuko Tsumoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Shinya Yamasaki
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan
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Predictive signs of peripheral rim instability with magnetic resonance imaging in no-shift-type complete discoid lateral meniscus. Skeletal Radiol 2021; 50:1829-1836. [PMID: 33677690 DOI: 10.1007/s00256-021-03753-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the associations between the preoperative MRI findings suggestive of meniscal instability and the intraoperative finding of peripheral rim instability (PRI) in patients with complete discoid lateral meniscus (CDLM) of no-shift-type, which was identified as the peripheral portion was not separated from the capsule. METHODS The records of 56 patients diagnosed with no-shift-type CDLM who underwent arthroscopic surgery were reviewed. We evaluated MRI findings of anterior parameniscal soft-tissue edema, linear fluid signal at the anterior meniscal margin, bulging of the meniscal margin, absence of popliteomeniscal fascicles, and hiatus widening on routine MRI. The positive predictive value (PPV), sensitivity, and specificity of these findings in predicting PRI were calculated; PRI was further investigated according to anterior and posterior location. RESULTS Linear fluid signal at the anterior meniscal margin and bulging had high PPV and specificity (P = .004 and = .029, respectively) for overall of PRI. The presence of either anterior parameniscal soft-tissue edema or linear fluid signal at the anterior meniscal margin predicted anterior PRI with high PPV, sensitivity, and specificity. Bulging of the meniscal margin had high specificity, and either bulging of the meniscal margin or absence of popliteomeniscal fascicle had high sensitivity in predicting posterior PRI. CONCLUSIONS A linear fluid signal at the anterior meniscus and anterior parameniscal soft-tissue edema were important signs of anterior PRI, whereas bulging of the margin had high specificity and either bulging of the meniscal margin or absence of popliteomeniscal fascicle had high sensitivity in detecting posterior PRI on routine MRI of no-shift-type CDLM. LEVEL OF EVIDENCE Level IV therapeutic case series.
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26
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Li Z, Fan W, Dai Z, Zhao H, Liao Y, Lei Y, Luo T, Liu Q, Li J. Widening of the popliteal hiatus on sagittal MRI view plays a critical role in the mechanical signs of discoid lateral meniscus. Knee Surg Sports Traumatol Arthrosc 2021; 29:2843-2850. [PMID: 32728789 DOI: 10.1007/s00167-020-06179-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/20/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE This study was undertaken to elucidate the clinical significance of widening of the popliteal hiatus on magnetic resonance imaging (MRI) after a torn discoid lateral meniscus (DLM). METHODS Included are 125 knees with meniscal disorders after arthroscopic surgery, divided according to preoperative MRI and symptoms into group A (torn DLM with mechanical symptoms,11 knees); group B (torn DLM without mechanical symptoms,41 knees); group C (asymptomatic DLM, 19 knees); and group D (medial meniscal tears, 54 knees). Popliteal hiatus width was measured on sagittal and coronal MRI. During arthroscopy, total meniscectomy or central partial meniscectomy combined repair of the remaining part was performed in group A and group B. Outcomes were evaluated with MRI, the Tegner, Lysholm Knee Scoring Scale, and visual analog scale (VAS) scores. RESULTS The preoperative width of the popliteal hiatus was significantly larger in group A than in groups C and D (P < 0.05) on both views. Group A had a wider popliteal hiatus on sagittal view compared with group B (P < 0.05); group B had a wider popliteal hiatus on coronal view compared with group D (P < 0.05). The width of the popliteal hiatus on sagittal view was significantly reduced after surgery in group A (P < 0.05). In groups A and B, Lysholm and Tegner scores were improved, while VAS scores were reduced (all P < 0.05). CONCLUSION Widening of the popliteal hiatus on MRI was correlated with torn DLM and accompanied mechanical symptoms. Arthroscopic central partial menisectomy and stabilization of the posterior part of the middle body anterior to the popliteus tendon were effective for the treatment of torn DLM. These findings may help guide appropriate treatment for torn DLM. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Zhou Li
- Department of Orthopedics, The First Affiliated Hospital of University of South China, Hengyang, 421001, Hunan, China
| | - Weijie Fan
- Department of Orthopedics, The First Affiliated Hospital of University of South China, Hengyang, 421001, Hunan, China
| | - Zhu Dai
- Department of Orthopedics, The First Affiliated Hospital of University of South China, Hengyang, 421001, Hunan, China.
| | - Heng Zhao
- Department of Radiology, The First Affiliated Hospital of University of South China, Hengyang, 421001, Hunan, China
| | - Ying Liao
- Department of Orthopedics, The First Affiliated Hospital of University of South China, Hengyang, 421001, Hunan, China
| | - Yunliang Lei
- Department of Orthopedics, The First Affiliated Hospital of University of South China, Hengyang, 421001, Hunan, China
| | - Tao Luo
- Department of Orthopedics, The First Affiliated Hospital of University of South China, Hengyang, 421001, Hunan, China
| | - Quanhui Liu
- Department of Orthopedics, The First Affiliated Hospital of University of South China, Hengyang, 421001, Hunan, China
| | - Jian Li
- Department of Orthopedics, The First Affiliated Hospital of University of South China, Hengyang, 421001, Hunan, China
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Turati M, Anghilieri FM, Accadbled F, Piatti M, Di Benedetto P, Moltrasio F, Zatti G, Zanchi N, Bigoni M. Discoid meniscus in human fetuses: A systematic review. Knee 2021; 30:205-213. [PMID: 33945980 DOI: 10.1016/j.knee.2021.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/02/2020] [Accepted: 04/09/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Discoid meniscus (DM) is a rare variant of regular knee anatomy. Compared to standard meniscus it is thicker and abnormal in shape; these characteristics make it more prone to tear. It is a congenital defect whose correct etiology is still debated and far from being clarified. The purpose of this systematic review is to evaluate evidences of DM in human fetuses in order to assess whether embryological development may have a role. METHODS A systematic review was performed on PubMed, Scopus, and Embase with different combinations of the keywords "discoid meniscus", "embryology", "fetus", "neonatal". Search yielded 1013 studies, on which we performed a primary evaluation. RESULTS Seven studies were considered including a total of 1378 fetal menisci specimens, from 396 different fetuses. Discoid shape was not found represented as a normal stage of prenatal development. From 782 lateral menisci analyzed, only 86 (10.86%) were discoid (13 complete, 73 incomplete type). None of medial menisci was found to be discoid. Lateral meniscus was observed to cover a larger surface of tibial plateau than medial one until 28th gestational week. CONCLUSION Lateral meniscus seems to be more prone to discoid shape for its natural tendency of covering a larger surface of the tibial plateau during fetal stages. However the fact that a discoid shape was not found in the majority of fetuses suggests that it is not a normal stage of fetal development. To support a single etiological factor it will be appropriate to have further morphological and morphometric studies.
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Affiliation(s)
- Marco Turati
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy; Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Department of Paediatric Orthopaedic Surgery, Hospital Couple Enfant, Grenoble Alpes University, Grenoble, France.
| | | | - Franck Accadbled
- Department of Orthopedics, Children's Hospital, Toulouse University Hospital, France
| | - Massimiliano Piatti
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy; Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France
| | - Paolo Di Benedetto
- Medical Departement (DAME) - University of Udine, Italy; Clinic of Orthopaedics, Friuli Centrale Healthcare and University Trust (ASUFC), Udine, Italy
| | | | - Giovanni Zatti
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Nicolò Zanchi
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Marco Bigoni
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy; Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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Ahn J, Lee SH. Editorial Commentary: Saucerization Is Superior to Total Meniscectomy in Patients With Symptomatic Discoid Lateral Meniscus. Arthroscopy 2021; 37:655-656. [PMID: 33546802 DOI: 10.1016/j.arthro.2020.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 02/02/2023]
Abstract
Current treatment recommendations favor meniscal rim preservation through partial meniscectomy with repair when indicated in patients with symptomatic discoid lateral menisci. Although many studies have shown the importance of meniscal rim preservation, some have shown that suture repair does not yield improved outcomes over partial meniscectomy without repair, considering the cost of repair and lack of available data. However, partial meniscectomy with repair is essential when peripheral instability is seen in patients with symptomatic discoid lateral menisci. Arthroscopic reshaping in young patients can be challenging for an inexperienced surgeon because visualization within the lateral joint space may be limited by a thickened meniscus and the small size of the pediatric knee. To preserve a stable peripheral rim, various meniscal repair methods should be used for stabilizing the reshaped meniscus on the capsule based on repair location, tear type, and surgeon preference.
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Geffroy L. Meniscal pathology in children and adolescents. Orthop Traumatol Surg Res 2021; 107:102775. [PMID: 33321242 DOI: 10.1016/j.otsr.2020.102775] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 02/03/2023]
Abstract
The menisci play a key role in knee biomechanics and long-term cartilage protection. Preserving the meniscus is thus a major functional consideration in children and adolescents. In normal menisci, lesions are traumatic in origin. They are often vertical, in the posterior segment, associated with anterior cruciate ligament tear. In abnormal menisci, lesions are much more specific to children, occurring atraumatically, mainly in discoid menisci. Clinical signs of traumatic meniscal lesion are minimal, and associated ligament involvement should be systematically screened for. In contrast, clinical findings are rich and specific in discoid malformative pathology, sometimes showing the typical "clunk" sign highly suggestive of a detachment. The complementary examination of choice is MRI. In children more than in adults, lesions need screening for in apparently normal menisci. This particularly concerns ramp lesions of the medial meniscus. It is important also to be aware of false signs, and notably linear hypersignal of vascular origin in the posterior segment of the medial meniscus. MRI is essential in determining type of tear and guiding surgery in discoid meniscal pathology. Indications for meniscal repair in children are maximal, even in lesions extending into the white zone, and the risk of failure needs to be assumed. All meniscal suture techniques - all-inside, in-out and out-in - need to be acquired. Meniscectomy, even partial, should be exceptional. Treatment of symptomatic discoid meniscus usually involves minimal central meniscoplasty and suture of the discovered lesion. Results of meniscal repair in children are generally very satisfactory, whatever the type or site of lesion. Vertical suture is to be preferred; suture failure is often only partial. In all, optimal treatment of meniscal pathology in children and adolescents requires perfect knowledge of pediatric specificities and above all mastery of repair techniques to restore meniscal tissue as fully as possible so as to conserve future knee function.
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Affiliation(s)
- Loïc Geffroy
- Chirurgie orthopédique et traumatologique, polyclinique Atlantique, avenue Claude-Bernard, 44800 Saint-Herblain, France.
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Nishino K, Hashimoto Y, Nishida Y, Yamasaki S, Nakamura H. Magnetic Resonance Imaging T2 Relaxation Times of Articular Cartilage Before and After Arthroscopic Surgery for Discoid Lateral Meniscus. Arthroscopy 2021; 37:647-654. [PMID: 33010327 DOI: 10.1016/j.arthro.2020.09.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 09/18/2020] [Accepted: 09/19/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To quantitatively evaluate degeneration of articular cartilage using magnetic resonance imaging (MRI) T2 mapping before and after arthroscopic surgery for discoid lateral meniscus (DLM). METHODS We retrospectively reviewed the medical records of patients who underwent arthroscopic reshaping surgery for symptomatic DLM from September 2013 to October 2017 and who had undergone follow-up for ≥2 years. MRI T2 relaxation examinations had been performed preoperatively and at 3, 6, 12, and 24 months postoperatively. The T2 relaxation times of the whole lateral femoral condyle and the tibial plateau were assessed. In addition, the lateral femoral condyle was divided into 3 subcompartmental areas: anterior, middle, and posterior. RESULTS In total, 30 knees of 27 patients were included in this study. The patients' mean age at operation was 13.3 years (range 6-23 years), and the mean follow-up period was 31.6 months. Saucerization alone was performed in 3 knees and saucerization with repair in 27 knees. The T2 relaxation time of the whole lateral femoral condyle was significantly increased at 3 and 6 months postoperatively and significantly decreased at 12 and 24 months. The T2 relaxation time of the whole lateral tibial plateau was significantly increased at 3 months postoperatively and significantly decreased at 24 months. The T2 relaxation time of the posterior subcompartment of the lateral femoral condyle was significantly increased at 3 months and significantly decreased at 12 and 24 months. CONCLUSIONS The T2 relaxation time of the lateral femorotibial joint cartilage increased at 3 and 6 months postoperatively and then had decreased at 12 and 24 months. Quantitative MRI allowed us to monitor the substantial changes in the cartilage during the early postoperative period and the recovery at the distant time point after reshaping surgery for DLM. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Kazuya Nishino
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yusuke Hashimoto
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
| | - Yohei Nishida
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shinya Yamasaki
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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Predictive factors for developing osteochondritis dissecans after surgery for discoid lateral meniscus are younger age and shorter meniscal width. Knee Surg Sports Traumatol Arthrosc 2021; 29:100-108. [PMID: 31642945 DOI: 10.1007/s00167-019-05750-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 10/07/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE This study aimed to identify the predictive factors for postoperative osteochondritis dissecans (OCD) in juvenile and adolescent knees with discoid lateral meniscus (DLM). METHODS In total, 242 patients with symptomatic DLM who underwent surgery were identified. Inclusion criteria were set as follows: (1) age ≤ 17 years with an open growth plate, (2) follow-up magnetic resonance imaging, and (3) absence of preoperative OCD. Consequently, 52 patients were retrospectively investigated. Average age during surgery, body mass index (BMI), and follow-up duration were 12 years [95% confidence interval (CI) 11-13], 19.2 kg/m2 (95% CI 18.4-20.1), and 27.3 months (95% CI 20.9-33.7), respectively. Age, sex, sports activities, BMI, symptomatic OCD in other joints, postoperative rehabilitation, preoperative shift of DLM by Ahn's classification, surgical procedures (saucerization alone or with stabilization, and subtotal meniscectomy), and postoperative meniscal width were analyzed as possible predictive factors. RESULTS Postoperatively, 42 patients without OCD and 10 with OCD were observed. In univariate analysis, younger age [odds ratio (OR) 1.5; p = 0.003], subtotal meniscectomy (OR 6.3; p = 0.027), and shorter meniscal width (OR 2.7; p = 0.005) were predictive factors for postoperative OCD. Multivariate analysis demonstrated that younger age (OR 1.6; p = 0.009) and shorter meniscal width (OR 1.5; p = 0.003) were predictive factors. CONCLUSIONS To prevent postoperative OCD after DLM surgeries, achieving stabilization with adequate meniscal width is necessary for juvenile knees. LEVEL OF EVIDENCE III.
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Kim SH, Lee JW, Kim KI, Lee SH. Can an injured discoid lateral meniscus be returned to the correct anatomic position and size of the native lateral meniscus after surgery? Knee 2021; 28:25-35. [PMID: 33279872 DOI: 10.1016/j.knee.2020.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/17/2020] [Accepted: 11/09/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND No previous studies have compared the position and size of the remaining discoid lateral meniscus (DLM) with that of a normal lateral meniscus. This study aimed to evaluate the postoperative position and size of DLM compared with that of normal controls using magnetic resonance imaging (MRI). METHODS This retrospective study involved 52 symptomatic complete type DLMs (discoid group) who underwent arthroscopic surgery and 50 normal controls (control group). Pre- and postoperative MRI evaluations, height, width, and relative percentage of extrusion (RPE) were assessed. Sagittal position parameters, including distances from articular cartilage center to anterior meniscus (CAMD) and from anterior articular cartilage margin to anterior horn (ACMD), were also assessed. Logistic regression analysis was performed to find factors with extrusion of remaining DLM. RESULTS The height of the discoid group was significantly lower than that of the control group (P = 0.000). RPE in the discoid group was significantly larger than in the control group (P = 0.005). Only CAMD and ACMD in the discoid group were different (positioned more anteriorly) from the control group (P = 0.000). Preoperative meniscal shift (odds ratio (OR): 12.448; P = 0.003) and operative technique, especially partial meniscectomy with repair (OR: 19.125; P = 0.000), were the major factors associated with extrusion. CONCLUSION The width of remaining DLM was comparable to that of normal controls, but the position was found to be more anterior and lateral than that of normal controls. Preoperative meniscal shift and combined meniscus repair were the major factors for smaller width and greater extrusion; thus, surgeons should address and counsel these factors before surgery.
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Affiliation(s)
- Seong Hwan Kim
- Department of Orthopedic Surgery, Hyundae General Hospital, Chung-Ang University, Republic of Korea; Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University, Republic of Korea
| | - Joong Won Lee
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Kang-Il Kim
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Sang Hak Lee
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.
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Perkins CA, Busch MT, Christino MA, Willimon SC. Saucerization and Repair of Discoid Lateral Menisci With Peripheral Rim Instability: Intermediate-term Outcomes in Children and Adolescents. J Pediatr Orthop 2021; 41:23-27. [PMID: 33044260 DOI: 10.1097/bpo.0000000000001695] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Historically, total meniscectomy was recommended as the treatment for a symptomatic discoid meniscus. Improved meniscal repair techniques and inferior long-term outcomes associated with meniscectomy have resulted in a trend toward meniscal preservation, with saucerization and repair of meniscocapsular tears. Reoperation rates after treatment of torn discoid menisci vary, with some series reporting high rates of reinjury and reoperation. The purpose of this study is to describe the intermediate-term outcomes of pediatric patients treated with saucerization and meniscocapsular repair of discoid lateral menisci with peripheral rim instability. METHODS A single-institution retrospective review was performed of consecutive patients less than 18 years of age treated with saucerization and repair for a meniscocapsular tear of a discoid lateral meniscus from 2013 to 2017. All patients had a minimum 24-month follow-up. A chart review was performed to describe tear location and repair type. The primary outcomes were revision meniscus surgery and Pedi-International Knee Documentation Committee and Tegner activity scores obtained at the final follow-up. RESULTS In total, 32 knees in 30 patients, including 15 males and 15 females with a mean age of 12 years (range, 5 to 17 y), were included. Tear patterns included anterior meniscocapsular (14 knees), posterior meniscocapsular (16 knees), and both anterior and posterior meniscocapsular (2 knees). Arthroscopic saucerization and meniscocapsular repair were performed in all knees. Repair types were outside-in (10 knees), inside-out (8 knees), all-inside (8 knees), and hybrid (6 knees). The mean follow-up was 54 months (range, 30 to 86 mo). Three knees (9%) underwent revision meniscus surgery, including 2 all-inside repairs and 1 partial meniscectomy. At the final follow-up, mean International Knee Documentation Committee score was 96 (range, 82 to 100). A total of 89% of patients reported returning to the same or higher level of activity following surgery. CONCLUSIONS Saucerization of discoid lateral menisci with repair of meniscocapsular tears is associated with low rates of revision surgery and good intermediate-term outcomes. LEVEL OF EVIDENCE Level IV.
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Meniscus repairs in the adolescent population-safe and reliable outcomes: a systematic review. Knee Surg Sports Traumatol Arthrosc 2020; 28:3587-3596. [PMID: 32979079 PMCID: PMC7654713 DOI: 10.1007/s00167-020-06287-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this study was to determine the outcomes of meniscus repair in the adolescent population, including: (1) failure and reoperation rates, (2) clinical and functional results, and (3) activity-related outcomes including return to sport. METHODS Two authors independently searched MEDLINE, Cochrane Central Register of Controlled Trials & Cochrane Library, and CINHAL databases for literature related to meniscus repair in an adolescent population according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. No meta-analysis was performed in this qualitative systematic review. RESULTS Thirteen studies, including no Level I, one Level II, one Level III, and eleven Level IV studies yielded 466 patients with 503 meniscus repairs. All defined meniscal re-tear as a primary endpoint, with a reported failure rate ranging from 0 to 42% at a follow-up ranging from 22 to 211 months. There were a total of 93 failed repairs. IKDC scores were reported in four studies with a mean improvement ranging from 24 to 42 (P < 0.001). Mean post-operative Lysholm scores were reported in seven studies, ranging from 85 to 96. Additionally, four of those studies provided mean pre-operative Lysholm scores, ranging from 56 to 79, with statistically significant mean score improvements ranging from 17 to 31. Mean post-operative Tegner Activity scores were reported in nine studies, with mean values ranging from 6.2 to 8. CONCLUSION This systematic review demonstrates that both subjective and clinical outcomes, including failure rate, Lysholm, IKDC, and Tegner activity scale scores, are good to excellent following meniscal repair in the adolescent population. Further investigations should aim to isolate tear type, location, surgical technique, concomitant procedures, and rehabilitation protocols to overall rate of failure and clinical and functional outcomes. LEVEL OF EVIDENCE IV.
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Kim JH, Ahn JH, Kim JH, Wang JH. Discoid lateral meniscus: importance, diagnosis, and treatment. J Exp Orthop 2020; 7:81. [PMID: 33044686 PMCID: PMC7550551 DOI: 10.1186/s40634-020-00294-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/22/2020] [Indexed: 11/10/2022] Open
Abstract
Discoid lateral meniscus (DLM) is a common anatomic variant in the knee typically presented in young populations, with a greater incidence in the Asian population than in other populations. As DLM is a congenital anomaly, the ultrastructural features and morphology differ from those of the normal meniscus, potentially leading to meniscal tears. Snapping and pain are common symptoms, with occasional limitations of extension, in patients with DLM. Examination of the contralateral knee is necessary as DLM affects both knees. While simple radiographs may provide indirect signs of a DLM, magnetic resonance imaging (MRI) is essential for diagnosis and treatment planning. Although DLM was traditionally classified into three categories, namely, complete, incomplete, and Wrisberg DLM, a recent MRI classification provides useful information for surgical planning because the MRI classification was based on the peripheral detachment in patients with DLM, as follows: no shift, anterocentral shift, posterocentral shift, and central shift. Asymptomatic patients require close follow-up without surgical treatment, while patients with symptoms often require surgery. Total or subtotal meniscectomy, which has been traditionally performed, leads to an increased risk of degenerative arthritis; thus, partial meniscectomy is currently considered the treatment of choice for DLM. In addition to partial meniscectomy, meniscal repair of peripheral detachment is recommended for stabilization in patients with DLM to preserve the function of the meniscus. Previous studies have reported that partial meniscectomy with or without meniscal repair is effective and shows superior clinical and radiological outcomes to those of total or subtotal meniscectomy during the short- to long-term follow-up. Our preferred principle for DLM treatment is reduction, followed by reshaping with reference to the midbody of the medial meniscus and repair as firm as possible.
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Affiliation(s)
- Jun-Ho Kim
- Department of Orthopedic Surgery, Seoul Medical Center, 156 Sinnae-ro, Jungnang-gu, Seoul, South Korea
| | - Jin Hwan Ahn
- Department of Orthopedic Surgery, Saeum Hospital, Seoul, South Korea
| | - Joo-Hwan Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, gangnam-gu, Seoul, 135-710, South Korea
| | - Joon Ho Wang
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, gangnam-gu, Seoul, 135-710, South Korea. .,Department of Health Sciences and Technology and Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, South Korea.
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Grimm NL, Pace JL, Levy BJ, Arthur D, Portman M, Solomito MJ, Weiss JM. Demographics and Epidemiology of Discoid Menisci of the Knee: Analysis of a Large Regional Insurance Database. Orthop J Sports Med 2020; 8:2325967120950669. [PMID: 32999890 PMCID: PMC7506788 DOI: 10.1177/2325967120950669] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 04/10/2020] [Indexed: 11/30/2022] Open
Abstract
Background: A discoid meniscus is a morphological variant of normal knee joint meniscus
shape and ultrastructure that can lead to traumatic tearing of this tissue
and early joint osteoarthritis. Purpose/Hypothesis: The purpose of this study was to determine the prevalence of discoid menisci
in a large, ethnically diverse regional cohort and to evaluate possible risk
factors. The hypothesis was that there would be no difference in the
epidemiological distribution of discoid menisci based on ethnicity or
sex. Study Design: Descriptive epidemiology study. Methods: The study population was from a regional, integrated health care system
cohort from Kaiser Permanente of Southern California that, as of 2016,
included more than 4.5 million patients. Patient demographics included age,
sex, and ethnicity within this cohort. Potential risk factors analyzed
included age, sex, ethnicity, and body mass index (BMI). Unique
characteristics of a discoid meniscus were analyzed, including a symptomatic
versus asymptomatic meniscus, location of meniscal tear and type of
meniscus, and frequency of meniscal surgical treatment. Results: A total of 223 patients with a confirmed discoid meniscus were identified,
yielding an overall prevalence rate of 4.88 per 100,000 patients. Those
identifying as Black had the lowest prevalence (2.68/100,000), while
Hispanic ethnicity had the highest (6.01/100,000). However, there was no
significant difference with regard to ethnicity (P = .283),
nor any significant difference between sexes. BMI did not significantly
influence the rate of discoid menisci (P = .504). A
majority (77.5%) of patients were symptomatic, while 22.5% of patients with
discoid menisci were asymptomatic and discovered incidentally. Symptomatic
discoid menisci were more likely to be operated on compared with
asymptomatic discoid menisci (71% vs 14%, respectively; P =
.001; odds ratio, 14.8 [95% CI, 5.8-37.2]). Horizontal and bucket-handle
tears were the more common tear types. Of the discoid menisci in this
cohort, 55.6% underwent surgery, with 95.2% undergoing reported
saucerization. Conclusion: In this very diverse population-based cohort of patients, there did not seem
to be a significant predilection of discoid menisci with regard to
ethnicity. Neither sex nor BMI significantly influenced the rate of discoid
menisci. More than three-quarters of those with a diagnosed discoid meniscus
were symptomatic. Of the tears that occurred with discoid menisci,
horizontal and bucket-handle tears made up the largest proportion.
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Affiliation(s)
- Nathan L Grimm
- Idaho Sports Medicine Institute, Boise State University, Boise, Idaho, USA.,Division of Sports Medicine, UConn Health, Farmington, Connecticut, USA
| | - James Lee Pace
- Division of Sports Medicine, UConn Health, Farmington, Connecticut, USA.,Elite Sports Medicine, Connecticut Children's Medical Center, Hartford, Connecticut, USA.,Quinnipiac University, Hamden, Connecticut, USA
| | - Benjamin J Levy
- Division of Sports Medicine, UConn Health, Farmington, Connecticut, USA
| | - D'Ann Arthur
- Department of Emergency Medicine, University of California, Davis, Sacramento, California, USA
| | - Mark Portman
- Department of Emergency Medicine, University of California, Davis, Sacramento, California, USA
| | | | - Jennifer M Weiss
- Department of Orthopedic Surgery, Los Angeles Medical Center, Kaiser Permanente, Los Angeles, California, USA
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Tapasvi S, Shekhar A, Eriksson K. Discoid lateral meniscus: current concepts. J ISAKOS 2020; 6:14-21. [PMID: 33833041 DOI: 10.1136/jisakos-2017-000162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 11/04/2022]
Abstract
The discoid meniscus is a congenital morphological abnormality encountered far more commonly on the lateral than the medial side. The discoid lateral meniscus (DLM) is more prevalent in Asia with an incidence of 10%-13%, than in the Western world with an incidence of 3%-5%. DLM can be bilateral in more than 80% cases. Due to its abnormal shape and size, the discoid meniscus is prone to tearing and has an impact on gait mechanics. The discoid meniscus has deranged collagen arrangement and vascularity which can have implications for healing after a repair. Patients with a DLM may or may not be symptomatic with mechanical complaints of locking, clicking, snapping or pain. Symptoms often arise due to a tear in the body of the meniscus or a peripheral detachment. Asymptomatic patients usually do not require any treatment, while symptomatic patients who do not have locking are managed conservatively. When a peripheral detachment is present, it must be stabilised while preserving the meniscus rim to allow transmission of hoop stresses. Rehabilitation after surgery is highly individualised and return to sports is possible after more than 4 months in those undergoing a repair. The functional outcomes and onset of radiographic arthritis after saucerisation and repairing a discoid meniscus are better in the long term, compared with a subtotal meniscectomy. However, there is no compelling evidence currently favouring a repair as results deteriorate with increasing follow-up. Poor prognosis is reported in patients undergoing a total meniscectomy, a higher age at presentation and valgus malalignment.
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Affiliation(s)
- Sachin Tapasvi
- Orthopaedics, Sahyadri Super Speciality Hospital Deccan Gymkhana, Pune, Maharashtra, India
| | - Anshu Shekhar
- Orthopaedics, Sahyadri Super Speciality Hospital Deccan Gymkhana, Pune, Maharashtra, India
| | - Karl Eriksson
- Orthopedic Surgery, Stockholm South Hospital, Karolinska Institutet, Stockholm, Sweden
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Yang SJ, Ding ZJ, Li J, Xue Y, Chen G. Factors influencing postoperative outcomes in patients with symptomatic discoid lateral meniscus. BMC Musculoskelet Disord 2020; 21:551. [PMID: 32799843 PMCID: PMC7429813 DOI: 10.1186/s12891-020-03573-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 08/06/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Due to its abnormal morphology and ultrastructure, discoid lateral meniscus (DLM) is prone to tear and degeneration, leading to clinical symptoms. Arthroscopy is the main treatment for symptomatic DLM; however, postoperative outcomes vary widely due to the effects of diverse factors. This research aims to explore the factors influencing postoperative outcomes of symptomatic DLM. METHODS Patients with DLM who underwent arthroscopic surgery at our hospital from 9/2008 to 9/2015 were enrolled according to the inclusion and exclusion criteria. Fourteen variables, including sex, body mass index (BMI) and other variables, were chosen as factors for study. Knee function was assessed using the International Knee Documentation Committee (IKDC) score. Univariate analyses (Mann-Whitney U test or Kruskall-Wallis rank sum test) and multivariate analyses (ordinal logistic regression) were used to identify the factors that influenced postoperative outcomes. P < 0.05 was considered statistically significant. RESULTS A total of 502 patients, including 353 females (70.3%) and 149 males (29.7%), were enrolled. The median IKDC score postoperatively (87.4; range, 41.4 ~ 97.7; IQR, 14.6) was higher than that preoperatively (57.6; range, 26.9 ~ 64.9; IQR, 9.7) (P < 0.001). Male sex was predictive of a higher IKDC score (P = 0.023, OR = 1.702). Compared with BMI ≥25 kg/m2, < 18.5 kg/m2 was associated with better IKDC score (P = 0.026, OR = 3.016). Contrasting with age of onset ≥45 years, ≤14 years (P < 0.001, OR = 20.780) and 14 ~ 25 years (P < 0.001, OR = 8.516) were associated with better IKDC score. In comparison with symptoms duration> 24 months, IKDC scores for patients with symptoms duration ≤1 month (P = 0.001, OR = 3.511), 1 ~ 6 months (P < 0.001, OR = 3.463) and 6 ~ 24 months (P < 0.001, OR = 3.254) were significantly elevated. Compared to Outerbridge grade III ~ IV, no injury (P < 0.001, OR = 6.379) and grade I (P = 0.01, OR = 4.332) were associated with higher IKDC score. CONCLUSIONS Arthroscopic treatment of symptomatic DLM is safe and effective, but its clinical efficacy is affected by many factors. Specifically, male sex, BMI < 18.5 kg/m2, age of onset < 25 years (especially < 14 years) and symptoms duration < 24 months are conducive to good postoperative outcomes. However, combined articular cartilage injury (Outbridge grade ≥ 2) reduces postoperative effect.
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Affiliation(s)
- Shun-Jie Yang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, 610041, China
| | - Zhong-Jun Ding
- Department of Orthopedic Surgery, West China Longquan Hospital Sichuan University, No.201, Yihe Group 3, Longquanyi District, Chengdu, 610100, China
| | - Jian Li
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, 610041, China
| | - Yang Xue
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, 610041, China
| | - Gang Chen
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, 610041, China.
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Carabajal M, Allende G, Masquijo J. Mid-term results of arthroscopic remodelling combined with peripheral repair in children with unstable discoid meniscus. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020. [DOI: 10.1016/j.recote.2020.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Prediction of the Peripheral Rim Instability of the Discoid Lateral Meniscus in Children by Using Preoperative Clinicoradiological Factors. J Pediatr Orthop 2020; 39:e761-e768. [PMID: 30950939 DOI: 10.1097/bpo.0000000000001370] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The discoid lateral meniscus (DLM) in children often presents peripheral rim instability (PRI) and is susceptible to tear or subluxation, which manifests symptoms and leads to a poor prognosis. We aimed to investigate the association between preoperative clinical and MRI findings and the intraoperative findings of PRI. METHODS Children and adolescents aged younger than 16 years who underwent surgical treatment for DLM were retrospectively reviewed. Cases of bucket-handle tear were not included because they would confound the stability of the peripheral rim. Total 60 knees from 47 children were included. PRI was additionally subdivided based on the location, such as anterior, middle, and posterior, during the investigation. RESULTS In multivariate analyses, both central (inward) (P=0.004) and external (outward) (P=0.029) displacement of lateral meniscal margin, and peripheral tear of the anterior body (P=0.022) were significant predictors of PRI, regardless of the location. The predictive factors for PRI based on each location were female gender (P=0.004), subjective symptom of clicking sound (P=0.023), and central displacement of the anterior meniscal margin (P=0.034) for anterior PRI; flexion contracture >10 degrees (P=0.017) and peripheral tear of the middle body (P<0.001) for middle PRI; and central displacement of the posterior meniscal margin (P=0.036) and peripheral tears of the anterior (P=0.029) and middle bodies (P=0.047) for posterior PRI. CONCLUSIONS We evaluated the preoperative clinical and MRI findings that predict PRI of pediatric DLM. Displacements of the DLM, not only centrally (inward) but also externally (outward), seem to be significant predictive factors for PRI. Furthermore, some clinical findings were associated with PRI, even predicting the locations. Although the actual surgical procedure should be determined by meticulous probing during arthroscopy, preoperative prediction of the presence and location of PRI would help decrease the risk of oversight during surgery. LEVEL OF EVIDENCE Level III-Diagnostic Study.
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Carabajal M, Allende GJ, Masquijo JJ. Mid-term results of arthroscopic remodelling combined with peripheral repair in children with unstable discoid meniscus. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019; 64:206-212. [PMID: 31826819 DOI: 10.1016/j.recot.2019.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 10/11/2019] [Accepted: 10/16/2019] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION The traditional treatment of unstable symptomatic discoid meniscus has been total or subtotal meniscectomy. However, long-term studies show that the results are poor. The aim of this study was to evaluate the clinical outcomes and survival of arthroscopic saucerization combined with peripheral repair for the treatment of symptomatic discoid meniscus in children. METHODS Patients≤18 years with discoid meniscus and a peripheral lesion treated between January 2012 and January 2018 were analyzed. Clinical results were evaluated using the Ikeuchi, Pedi-IKDC and Lysholm scales. The survival analysis was performed with the Kaplan-Meier method. RESULTS Eighteen patients (18 knees) were treated in the evaluated period. The average age at the time of surgery was 11.1±3.8 years. The average follow-up was 40.4±21.2 months. An average of 3.4±1 meniscal sutures (range, 2 to 6) was used. Repairs were carried out with a combination of inside-out and outside-inside techniques as dictated by the configuration of the injury. Sixteen patients could be evaluated functionally (2 lost of follow-up). Four patients presented mechanical symptoms. One was treated conservatively with physical therapy and 3 (18.8%) required further surgical treatment (subtotal meniscectomy). According to the Ikeuchi scale 12 (75%) had excellent results, one (6.2%) good and 3 (18.8%) poor (repair failure). The average Pedi-IKDC and Lysholm scores were 98.3±2 and 98.7±2.9 respectively at the last follow-up. The overall Kaplan-Meier survival probabilities after repair were 93.7% at one year, and 85.9% at 2 years. CONCLUSIONS Mid-term outcomes of saucerization in conjunction with meniscal repair are encouraging for children with a symptomatic unstable discoid meniscus.
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Affiliation(s)
- M Carabajal
- Departamento de Ortopedia y Traumatología Infantil, Sanatorio Allende, Córdoba, Argentina
| | - G J Allende
- Departamento de Ortopedia y Traumatología Infantil, Sanatorio Allende, Córdoba, Argentina
| | - J J Masquijo
- Departamento de Ortopedia y Traumatología Infantil, Sanatorio Allende, Córdoba, Argentina.
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Factors associated with bilateral discoid lateral meniscus tear in patients with symptomatic discoid lateral meniscus tear using MRI and X-ray. Orthop Traumatol Surg Res 2019; 105:1389-1394. [PMID: 31607576 DOI: 10.1016/j.otsr.2019.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/23/2019] [Accepted: 08/22/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The incidence of bilateral discoid lateral meniscus (DLM) is as high as 73 to 85%, and associated contralateral meniscus tears ranged from 4 to 33% in symptomatic surgical DLM. The goal of the study was analyzing the factors that predict contralateral presence and tearing of DLM in patients who underwent surgery for symptomatic DLM. Our hypothesis was that there is a significant correlation between operative DLM properties and the incidence of bilateral DLM with associated contralateral meniscus tears. These properties include tear patterns, younger patient age, and characteristic X-ray findings. PATIENTS AND METHODS This prospective study included 76 patients who underwent arthroscopic surgery for symptomatic DLM. The contralateral knees were evaluated with X-ray and MRI. Based on the MRI findings, DLM was categorized into three types, and tear patterns were analyzed. The characteristic X-ray findings were evaluated as follows: (1) high fibular head, (2) squared-off appearance of the lateral femoral condyle, (3) cupping of the lateral tibial plateau, (4) widened femorotibial joint space, (5) hypoplasia of the lateral intercondylar spine, (6) notching of the LFC. The number of characteristic X-ray findings (0/1/more than 2) was noted. Binary logistic analysis was performed to find the factors that predict the presence and tear of contralateral DLM. RESULTS MRI of contralateral knees revealed 43 cases (57%) of complete DLM, 25 cases (33%) of incomplete DLM, and 8 cases (11%) of normal meniscus. Meniscus tears were found in 29 cases (38%) in the contralateral knee. X-ray of the contralateral knee revealed that 27 patients (36%) had one and 24 patients (32%) had two or more characteristic X-ray findings. On logistic regression analysis, the associations between contralateral knee meniscal tear and the presence of one or more than two characteristic X-ray findings were statistically significant (OR: 16.5, p=0.028; OR: 264.0, p=0.000, respectively). DISCUSSION The number of characteristic X-ray findings in the contralateral knee is a significant predictive factor for contralateral DLM type and/or tear. Symptomatic DLM patients with characteristic X-ray findings should be carefully evaluated for contralateral DLM and meniscal tears. LEVEL OF EVIDENCE III, prospective diagnostic study of consecutive patients.
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Cho WJ, Kim JM, Lee BS, Kim HJ, Bin SI. Discoid lateral meniscus: a simple horizontal tear was associated with less articular cartilage degeneration compared to other types of tear. Knee Surg Sports Traumatol Arthrosc 2019; 27:3390-3395. [PMID: 30888447 DOI: 10.1007/s00167-019-05363-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 01/18/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE The relationship between the tear type of discoid lateral meniscus (DLM) and articular cartilage degeneration has not been well studied. METHODS Data from patients with DLM tears who underwent arthroscopic surgery, between 2008 and 2016, were reviewed retrospectively. Demographic variables were obtained from medical records. The types of DLM and meniscal tear and status of cartilage were assessed using operation records and arthroscopic images. Patients were assigned to horizontal or non-horizontal tear groups according to the types of the tear. Factors affecting cartilage degeneration of the lateral femoral condyle (LFC) and lateral tibial plateau (LTP) were identified using logistic regression analysis. The horizontal tear group was divided into two subgroups on the basis of the median value of duration of symptoms and difference in cartilage degeneration between the two subgroups was evaluated. RESULTS Overall, 355 knees were enrolled and assigned to the horizontal (n = 53) or the non-horizontal (n = 302) tear groups. The incidence of International Cartilage Repair Society grades 2-4 cartilage lesions of the LFC (0%, P < 0.001) and LTP (24.5%, P < 0.001) was significantly lower in the horizontal tear group than in the non-horizontal tear group. Horizontal tear [LFC, odds ratio (OR) = 0.02, P < 0.001; LTP, OR = 0.27, P < 0.001] and age (LFC, OR = 1.04, P < 0.001; LTP, OR = 1.03, P < 0.001) were significantly related to cartilage status. There was no difference in cartilage degeneration between the two subgroups in the horizontal tear group. CONCLUSIONS A simple horizontal tear was associated with less articular cartilage degeneration compared to other types of tear in the DLM. In the case of simple horizontal tear, there was no difference in the degree of cartilage degeneration according to the duration of symptoms. Therefore, it is not necessary to perform surgical treatment promptly in cases of simple horizontal tears unless the patient's symptoms are severe. LEVEL OF EVIDENCE III, Case-Control Study.
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Affiliation(s)
| | - Jong-Min Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| | - Bum-Sik Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Hyo-June Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Seong-Il Bin
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
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Zhou Z, Xiao L, He C, Zhang Y, Xue C, Qiao S, Zhang G, Wang Z. Application of assisted portal under anterior horn of lateral meniscus for the treatment of discoid meniscus injury. Knee 2019; 26:1125-1135. [PMID: 31351849 DOI: 10.1016/j.knee.2019.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 05/05/2019] [Accepted: 07/02/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The assisted inferior anterolateral portal under anterior horn of the lateral meniscus (UAHLM portal) was applied to treat the lateral discoid meniscus injury conveniently and the clinical outcomes were evaluated. METHODS A retrospective review was conducted on 60 patients who underwent arthroscopic surgery with a symptomatic discoid lateral meniscus. Normal anterolateral/anteromedial portals assisted with UAHLM portal (1-2 cm inferior to the anterolateral portal) were used. All patients were followed up for 24-48 months (median, 33 months) and evaluated by MRI images and clinical outcomes including clinical findings, Lysholm scores and IKDC scores. RESULTS After meniscus plasty with or without repair, most of the upper layer of lateral meniscuses was retained. A total of 54 patients (16 males and 38 females, 42 ± 17.8 years old) showed satisfactory clinical results without requiring reoperation after a median follow-up time of 33 months. At final follow-up, a full range of motion was achieved in all patients. MRI indicated the thickness of anterior horn of lateral meniscus was (5.38 ± 1.09 mm) before the operation and (4.04 ± 0.71 mm) after the operation at the 2-year follow-up; clinical outcomes were improved significantly than the baseline: positive McMurray test (50 vs. 2, P< 0.001), Lysholm score (64.9 ± 9.0 vs. 94.7 ± 4.9, P< 0.001), and IKDC score (54.4 ± 7.7 vs. 92.6 ± 4.3, P< 0.001). No significant complication was observed during the follow-up. CONCLUSION Thus, this technique with assisted UAHLM portal was convenient for arthroscopic discoid meniscus plasty and meniscus repair and served as an effective method in patients with a symptomatic discoid lateral.
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Affiliation(s)
- Zhiyou Zhou
- Department of Orthopedics, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Lei Xiao
- The Orthopedics Department, NO.515 Hospital of PLA, Wuxi, China
| | - Chongru He
- Department of Orthopedics, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Yongjin Zhang
- Department of Orthopedics, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Chenchen Xue
- Department of Orthopedics, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Suchi Qiao
- Department of Orthopedics, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Guobin Zhang
- Department of Orthopedics, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Zimin Wang
- Department of Orthopedics, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China.
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Ring-shaped meniscus formation may arise from the regenerative response to meniscectomy during growth spurts: A case report. Int J Surg Case Rep 2019; 61:226-229. [PMID: 31377550 PMCID: PMC6698273 DOI: 10.1016/j.ijscr.2019.07.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/16/2019] [Accepted: 07/19/2019] [Indexed: 11/24/2022] Open
Abstract
We presented a case of newly formed ring-shaped meniscus-like tissue after partial resection of discoid lateral meniscus. The newly formed interhorn bridge could have represented a meniscus-like tissue that appeared secondary to tissue repair. Intra-patient findings indicate that growth spurts may promote the tissue repair.
Introduction Ring-shaped meniscus is very rare and generally considered to be a congenital malformation. Here, we report a case of newly formed ring-shaped meniscus-like tissue following arthroscopic partial meniscectomy for a complete discoid lateral meniscus. Presentation of case A 14-year-old boy underwent arthroscopic partial meniscectomy for complete discoid lateral meniscus of the left knee. The growth plates were present at the surgery. Although pain improved immediately after surgery, he reported left knee pain at the 7-month follow-up. Magnetic resonance imaging revealed a bucket-handle tear of the lateral meniscus and a second arthroscopic surgery was performed. During arthroscopy, we found that the anterior and posterior horns of the lateral meniscus were connected by meniscus-like tissue forming a ring-shaped meniscus and the newly formed interhorn meniscal bridge was resected. Histological evaluation indicated that the newly formed tissue was meniscus-like tissue that had appeared secondary to tissue repair. He visited our hospital at 16 years old, after the growth plates had closed, complaining of right knee pain. Arthroscopic partial meniscectomy was performed for complete discoid lateral meniscus of the right knee. As of two years after this surgery, no morphological changes have been observed. Discussion Although the exact mechanisms of meniscus-like tissue formation remain unclear, the growth spurt may promote the mechanisms of tissue repair, forming ring-shaped meniscus-like tissue. Conclusion This is the first case of ring-shaped meniscus-like tissue forming after partial resection of a complete discoid lateral meniscus. Ring-shaped meniscus-like tissue can develop in growing patients.
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Midbody of the medial meniscus as a reference of preservation in partial meniscectomy for complete discoid lateral meniscus. Knee Surg Sports Traumatol Arthrosc 2019; 27:2558-2567. [PMID: 30406407 DOI: 10.1007/s00167-018-5268-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/23/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To evaluate the postoperative size of discoid lateral meniscus using magnetic resonance imaging (MRI) after partial meniscectomy relative to the size of medial meniscus midbody. METHODS This study included 48 patients who underwent arthroscopic partial meniscectomy with or without repair for symptomatic complete discoid meniscus. The intraoperative size of midbody of medial meniscus was used as a reference for partial meniscectomy. MRIs were performed pre- and postoperatively. Quantitative evaluations of the height, width, extrusion of the meniscus, and relative percentage of extrusion in the coronal and sagittal planes were completed. Demographic data, preoperative shift, type of shift, and operative technique were analyzed while considering the remaining meniscus. Logistic regression analyses were used. RESULTS The mean remaining discoid meniscal width in the coronal plane of MRI was not significantly different from the width of midbody of medial meniscus (9.1 ± 4.2 mm vs. 9.4 ± 1.4 mm, n.s.) Absolute meniscal extrusion and relative percentage of extrusion in the coronal plane and the ratio of t meniscus in sagittal plane of the final MRI were significantly increased as compared with the preoperative MRI. Preoperative shift was a risk factor for the reduction of remaining meniscal width (odds ratio 11.997, p = 0.016, 95% CI 1.586-90.737). CONCLUSION The size of midbody of medial meniscus could be a reference for partial meniscectomy in symptomatic complete discoid meniscus. Preoperative shift represents a risk factor for decreased remaining meniscal width. These findings could be helpful in ensuring appropriate surgical planning and explaining poor prognostic factors. LEVEL OF EVIDENCE Prospective cohort study, Level II.
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Shea KG, Dingel AB, Styhl A, Richmond CG, Cannamela PC, Anderson AF, Ganley TJ, Hill A, Yen YM. The Position of the Popliteal Artery and Peroneal Nerve Relative to the Menisci in Children: A Cadaveric Study. Orthop J Sports Med 2019; 7:2325967119842843. [PMID: 31286001 PMCID: PMC6600506 DOI: 10.1177/2325967119842843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Meniscal injury in skeletally immature patients is increasingly reported.
During meniscal repair, all-inside devices may protrude beyond the posterior
limits of the meniscus, putting the neurovascular structures at risk. Purpose: The purposes of this study were (1) to examine the relationship between the
popliteal artery and the posterolateral and posteromedial aspects of the
menisci, (2) to examine the relationship of the peroneal nerve to the
posterolateral meniscus, and (3) to develop recommendations for avoiding
neurovascular injury during posterior meniscal repair in pediatric
patients. Study Design: Descriptive laboratory study. Methods: A total of 26 skeletally immature knee cadaveric specimens (7 females and 19
males) were included. Specimens were divided into age groups: 2-4, 5-8, and
9-11 years. The most posterior extent of the lateral and medial menisci was
identified via sagittal and axial views on computed tomography (CT) scans.
The shortest distance from the most posterior aspect of the lateral and
medial menisci to the popliteal artery and the shortest distance from the
posterior aspect of the lateral menisci to the anterior rim of the peroneal
nerve were measured, and 3-dimensional models of representative specimens
were re-created through use of CT scans. Results: For the age groups 2-4, 5-8, and 9-11 years, the mean minimum distance from
the posterolateral meniscus to the popliteal artery was 5.2, 6.7, and 8.2
mm, respectively, and the mean minimum distance from the posteromedial
meniscus to the popliteal artery was 12.7, 15.4, and 20.3 mm, respectively.
In all groups, the distance between the posteromedial meniscus and the
popliteal artery was greater than that between the posterolateral meniscus
and the popliteal artery. The mean distance from the peroneal nerve to the
lateral meniscus was 13.3, 15.0, and 17.9 mm for the respective groups. Conclusion: Many all-inside meniscal repair devices have sharp tips that penetrate
posterior to the meniscus and capsule. This study demonstrated that the
distance between the posterior meniscus and popliteal artery is relatively
small in pediatric patients, especially for the lateral meniscus region. Clinical Relevance: Because of the higher potential for meniscal healing, meniscal repair is more
likely to be performed in pediatric patients. The data in this study
regarding the proximity of the lateral meniscus and neurovascular structures
may be used to guide safe surgical repair of posterior meniscal tears during
the use of all-inside meniscal repair devices in these patients.
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Affiliation(s)
- Kevin G Shea
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - Aleksei B Dingel
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - Alexandra Styhl
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Connor G Richmond
- College of Osteopathic Medicine, University of New England, Biddeford, Maine, USA
| | | | - Allen F Anderson
- Author deceased.,Tennessee Orthopaedic Alliance, Nashville, Tennessee, USA
| | | | - Andrew Hill
- Department of Orthopaedic Surgery, Children's Hospital of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yi-Meng Yen
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
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Lee DH, D'Lima DD, Lee SH. Clinical and radiographic results of partial versus total meniscectomy in patients with symptomatic discoid lateral meniscus: A systematic review and meta-analysis. Orthop Traumatol Surg Res 2019; 105:669-675. [PMID: 31027980 DOI: 10.1016/j.otsr.2019.02.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/24/2019] [Accepted: 02/14/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Some reports have noted favorable long-term clinical results with milder postoperative arthritic changes after total meniscectomy in symptomatic patients with torn discoid lateral meniscus (DLM). This meta-analysis was conducted to compare the clinical and radiographic results between partial and total meniscectomy in patients with symptomatic DLM. METHODS Studies were included in the meta-analysis if (1) they analysed patients who underwent arthroscopic surgeries for DLMs, (2) they directly compared clinical outcomes in patients treated with partial and total meniscectomies, (3) they analysed at least one parameter related to postoperative outcomes, including the Ikeuchi scale, and/or radiographic results including the Tapper and Hoover classification. RESULTS Eight studies were finally included. The proportion of the knees with excellent or good grade appeared to be higher in partial than in total meniscectomy group, but this difference did not reach statistical significance [128/158 (81.0%) vs. 87/131 (66.4%); OR 1.62; p=0.10; I2=0%]. The pooled results of the proportion of normal cartilage status or mild chondral wear (grade 0 or 1 of the Tapper and Hoover classification) were significantly much higher with partial than with total meniscectomy [228/261 (87.4%) vs. 94/169 (55.6%); OR 9.08; p<0.001; I2=57%]. CONCLUSION This meta-analysis showed that the radiographic outcomes of DLM were better with partial meniscectomy with or without repair than with total meniscectomy, but their clinical outcomes were similar. The findings thus suggest that meniscal preservation would be a better option than total meniscectomy for symptomatic DLM. LEVEL OF EVIDENCE II, Systematic review and Meta-analysis.
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Affiliation(s)
- Dae-Hee Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Darryl D D'Lima
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, United States
| | - Sang Hak Lee
- Department of Orthopaedic Surgery, Center for Joint Diseases and Rheumatism, Kyung Hee, University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, 134-727 Seoul, Republic of Korea.
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Kinugasa K, Hamada M, Yonetani Y, Matsuo T, Mae T, Nakata K, Horibe S. Discoid lateral meniscal repair without saucerization for adolescents with peripheral longitudinal tear. Knee 2019; 26:803-808. [PMID: 31076246 DOI: 10.1016/j.knee.2019.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 12/18/2018] [Accepted: 03/17/2019] [Indexed: 02/02/2023]
Abstract
Recently, successful clinical outcomes for symptomatic discoid lateral meniscus (DLM) have been reported following partial meniscectomy (saucerization) with repair. In contrast, some studies using radiography and magnetic resonance imaging (MRI) have suggested that function of load transmission might not be appropriately maintained after saucerization with repair. Therefore, in pursuit to uphold load transmission after surgery for DLM, this study tried to preserve the DLM shape to keep the original DLM function. Discoid lateral meniscus repair without saucerization was indicated, with strict criteria, for those who had a painful peripheral longitudinal tear with purely intact body caused after a single traumatic incidence. The repair was performed without saucerization for four adolescents (two males, two females; mean age 16.2 years; three complete types of DLM, and one incomplete type of DLM). Postoperatively, the following were evaluated with radiography and MRI at six, 12, and 24 months after surgery: clinical outcomes, degenerative changes, and morphology of repaired DLM. They all showed good clinical outcomes. Furthermore, no degeneration, deformation, nor extrusion was observed at the two-year follow-up after surgery. For limited cases of DLM, as mentioned above, DLM repair without saucerization can be one treatment option.
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Affiliation(s)
- Kazutaka Kinugasa
- Department of Sports Orthopaedics, Osaka Rosai Hospital, Osaka, Japan
| | - Masayuki Hamada
- Department of Orthopaedic Surgery, Hoshigaoka Medical Center, Osaka, Japan.
| | - Yasukazu Yonetani
- Department of Orthopaedic Surgery, Hoshigaoka Medical Center, Osaka, Japan
| | - Tomohiko Matsuo
- Department of Orthopaedic Surgery, Moriguchi Keijinkai Hospital, Osaka, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine Osaka, Japan
| | - Ken Nakata
- Department of Health and Sport Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shuji Horibe
- Faculty of Comprehensive Rehabilitation, Osaka Prefecture University, Osaka, Japan
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Abstract
PURPOSE OF REVIEW The purpose of this study was to review the clinical and functional outcomes of meniscus repair in children and adolescents. RECENT FINDINGS The sequel of meniscal tears and the outcome of meniscus repair have been well studied in adults. However, these topics have received less attention in the pediatric population despite the high prevalence and potentially critical effect on long-term knee function in children. Meniscus repair has a healing rate ranging from 33 to 100% with less than 40% reoperation rate. Several factors have been suggested to play a role in healing, such as concomitant ACL reconstruction and complexity of the tear. There is a lack of standardization among the utilization of functional outcome and activity level questionnaires across studies; however, most report improved function postoperatively. Other important considerations include bucket handle tears, the discoid meniscus, rehabilitation and return to sports, and alternatives after failed meniscus repair. Based on the favorable outcomes reported, meniscus repair should be attempted in most meniscus tears in children.
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Affiliation(s)
- Brian W Yang
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Elizabeth S Liotta
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nikolaos Paschos
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
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