Arthroscopic Split Transpositional Repair for Torn Complete Discoid Lateral Meniscus

Abstract

A 20-year-old man presented with a 5-year history of pain in his left knee. He reported intermittent swelling and pain, especially after sporting activities. Arthroscopic surgery revealed that the entire anterior and mid-body of the discoid meniscus had been lost, and the remaining portion was shifted to posterocentral direction. Considering his age, resection of the entire meniscus was initially thought to be undesirable, although there was strong possibility of a re-tear. Although there was considerable anterocentral loss of the meniscus, the thickened inner portion of meniscus, which was displaced to the intercondylar notch, had remained relatively intact. Therefore, the lost part of the meniscus was reconstructed by transposing the remaining inner fragment. Margins of the torn side were freshened and abraded. The thick inner portion of remnant meniscus was reshaped by trimming the inferior portion. Subsequently, the posteromedial corner of remnant discoid meniscus was divided. The inner portion of the torn discoid meniscus was then flipped to the position of anterior and mid-body of the meniscus. The transposed portion was repaired using outside-in sutures and augmented with an exogenous blood clot. Surprisingly, follow-up magnetic resonance images at 40 months confirmed healing, and the patient was satisfied with the surgical outcome.