Symptomatic Discoid Lateral Meniscus Research Articles

Meniscoplasty for lateral discoid meniscus tears: Long-term results of 14 cases

IntroductionDiscoid lateral meniscus lesions are relatively rare. The objective of this study was to determine the long-term results of 14 cases of discoid lateral meniscus tears treated by arthroscopic meniscoplasty between July 1991 and May 2009, and to assess the development of osteoarthritis in the lateral compartment. MethodsThe series consisted of 10 patients (14 knees): 3 girls under the age of 15, 3 men and 4 women aged from 16 to 47 years (mean age: 31.4±11.1 years). The main reason for consultation was pain in 10 cases, locking in 2 cases and pain associated with locking in 2 cases. The diagnosis was confirmed preoperatively by MRI in 10 cases, CT-arthrography in 1 case and arthrography in 3 cases. The indication for surgery was made because of a symptomatic discoid lateral meniscus. All cases were treated by arthroscopic meniscal reshaping. Functional results were evaluated using the Lysholm–Tegner, IKDC, KOOS and satisfaction scores. Radiological results were evaluated based on the modified Alhbäck classification for osteoarthritic (OA) changes. ResultsNo complications were found. Two patients were lost to follow-up. The remaining eight patients (12 knees) were reviewed at a mean of 157.5±72.1 months (61–276). The mean Lysholm–Tegner score was 88.9±10.6 points (67–100), the mean KOOS was 92.4±9.5 (65–100) and the mean IKDC score was 85.4±16.5 points (65–100). All eight of the reviewed patients were satisfied or very satisfied with the result. Radiological analysis found that five knees had no signs of OA, five knees had stage 1, one had stage 2 and one had stage 3. At last follow-up, no patient had been reoperated. ConclusionMeniscoplasty of discoid lateral meniscus tears leads to excellent long-term functional results despite signs of osteoarthritic changes in the lateral compartment of the knee. Level of evidenceIV (retrospective study).

Prevalence of bilateral Discoid Lateral Menisci (DLM) in patients operated for symptomatic DLM with a follow-up study on their asymptomatic contralateral knees: a Magnetic Resonance Imaging (MRI) assessment.

BackgroundThe purpose was to investigate prevalence of bilateral discoid lateral menisci (DLM) in Han Chinese patients who received surgery for symptomatic DLM, as well as a follow-up study of their asymptomatic contralateral knees using magnetic resonance imaging (MRI).MethodsA total of 110 patients [50 males and 60 females; average age: 21.95 ± 12.77 years (range: 6 to 67 years)] admitted to our hospital with symptomatic DLM were treated with arthroscopic surgery. The contralateral asymptomatic knees were evaluated for DLM by MRI. Postoperative clinical evaluation was performed using the Lysholm knee scoring scale and International Knee Documentation Committee subjective knee evaluation.ResultsEighty (72.73 %) of 110 symptomatic DLM patients had bilateral DLM, of which 68 (85 %) were of homotype (same type). Fourteen of 80 bilateral DLM patients were symptomatic and received operations in both knees. Twelve of remaining 66 bilateral DLM patients with asymptomatic one knee underwent a second arthroscopic surgery as their asymptomatic knees became symptomatic over the five-year interim. Of these 12 cases, seven exhibited no shift and five showed posterocentral meniscal shift. Furthermore, at least two cases showed progression from asymptomatic grade II to symptomatic grade III over the interim. All patients showed significant improvement after surgery.ConclusionsThe bilateral DLM rate of Han Chinese patients with symptomatic DLM was relatively high at 72.7 %, and 85 % of those were of homotype.

Long-Term Clinical Follow-Up of Arthroscopic Treatment of Symptomatic Discoid Lateral Meniscus in Children

The purpose of this study was to examine the long-term clinical outcomes of arthroscopic partial meniscectomy for the treatment of discoid lateral meniscus in children. A previous study at our institution identified twenty-seven consecutive patients that underwent arthroscopic meniscal saucerization by one of two surgeons between 1997 and 2002. These patients were included in this study if they were willing and able to complete the five outcomes questionnaires. Seven additional patients that were treated consecutively at least 10 years ago were also included in the study. Patients were also offered a knee exam performed by one of the two surgeons. Associations between outcome scores and discoid type, location of instability, and age at surgery were identified. Of the 34 eligible patients (23 female, 11 male), 22 patients were contacted, and 21 agreed to participate. The average length of follow-up was 13.7 years, ranging from 10.3-16.6 years. Average age at surgery was 9.3 years. Long-term follow-up revealed average IKDC, Kujala, and Lysholm scores of 82.87, 86.63 and 83.73, respectively. Additionally, Marx and Tegner scores were 5.36 and 5.63, respectively. Stratifying the Lysholm scores revealed outcomes that were 45.4% excellent, 18.2% good, 27.3% fair, and 9.1% poor. The average IKDC Knee Examination score was A (normal). Overall, 20.6% (7 of 34) of patients underwent a subsequent surgical procedure on the affected knee. Numerous studies have demonstrated good to excellent short-term outcomes after arthroscopic treatment of discoid meniscus. At an average follow-up of nearly 14 years, our data suggests that clinical outcome scores decline over time. Compared to our 2-year follow-up study, there is an increased rate of knee pain, mechanical symptoms, and functional limitations. The overall modest results demonstrate the challenging clinical problem of discoid lateral meniscus in young patients and illustrate the need for further solutions for meniscus repair or replacement.

Long-Term Results of Arthroscopic Reshaping for Symptomatic Discoid Lateral Meniscus in Children

To assess the long-term clinical and radiographic results of arthroscopic reshaping with or without peripheral meniscus repair for the treatment of symptomatic discoid lateral meniscus in children. This study included 38 children (48 knees) who underwent arthroscopic surgery for symptomatic discoid lateral meniscus. The mean age at operation was 9.9 years (range, 4 to 15 years), and the mean follow-up period was 10.1 years (range, 8 to 14 years). Arthroscopic partial meniscectomy was performed in 22 knees (group A); partial meniscectomy with repair, in 18 knees (group B); and subtotal meniscectomy, in 8 knees (group C). Clinical and radiographic results were evaluated preoperatively and at the final follow-up. According to the scale of Ikeuchi, 94% of cases showed excellent or good results clinically. At the final follow-up, the median Tegner activity level was 7 (range, 4 to 10). The mean Lysholm knee score improved from 74.9 ± 10.6 to 97.6 ± 4.0, and the mean Hospital for Special Surgery score improved from 80.8 ± 8.9 to 97.8 ± 3.6 (P < .0001). At the final follow-up, radiographic evaluation showed the development of minor osteophytes in the lateral compartment of 18 knees and moderate joint space narrowing with spur formation in 1 knee. In addition, degenerative changes were observed in 23% of cases in group A, 39% of cases in group B, and 88% of cases in group C. Group C showed significantly greater progression of degenerative changes than group A or B. Arthroscopic reshaping for symptomatic discoid lateral meniscus in children led to satisfactory clinical outcomes after a mean of 10.1years. However, progressive degenerative changes appeared in 40% of the patients. The subtotal meniscectomy group had significantly increased degenerative changes compared with partial meniscectomy with or without repair. Level IV, therapeutic case series.

Bilateral occurrence and morphologic analysis of complete discoid lateral meniscus.

PurposeThe aim of the study was to investigate and analyze bilateral incidence and morphology of complete discoid lateral meniscus (DLM) with possible relation to tears and symptoms in knee joints.Materials and MethodsThirty-eight consecutive patients with symptomatic or already-torn complete DLM on magnetic resonance imaging in a unilateral knee underwent diagnostic arthroscopy on both knee joints upon agreement. The presence and shape of complete DLM as well as presence and pattern of tear were recorded accordingly.ResultsIn total, 89.5% (34 of 38 patients) showed bilateral complete DLM, and 84.2% yielded bilateralism with identical shape. Cape-slab was the most frequent shape, comprising 68.8% of patients with identically-shaped bilateral DLM overall. Tear patterns were more frequent, in the order of longitudinal, simple horizontal, radial, and degenerative; however, the morphological shape of complete DLM was not significantly related to tear incidence or pattern. Meniscus tears and knee symptoms occurred in the contralateral knee with incidences of 32.4% and 26.5% in patients with bilateral complete DLM, respectively.ConclusionBased on these findings, more aggressive warning on the presence of discoid pathology and the need for evaluation on the contralateral knee should be considered during consultation with patients with symptomatic complete DLM in a unilateral knee in the outpatient clinic.

Do the radiographic findings of symptomatic discoid lateral meniscus in children differ from normal control subjects?

The aim of this study was to quantitatively compare radiographic findings of symptomatic discoid lateral meniscus in children with those of matched controls. Seventy-eight consecutive children (91 knees) who underwent arthroscopic surgery for a symptomatic discoid lateral meniscus (discoid group) were included. Another 91 age- and sex-matched controls with normal medial and lateral menisci on the basis of magnetic resonance imaging findings were included in this study (control group). Each plain radiograph was evaluated from the anteroposterior view for the following variables: height of the lateral tibial spine, lateral joint space distance, height of the fibular head, squaring of the lateral femoral condyle, obliquity of the lateral tibial plateau and cupping of the lateral tibial plateau. Lateral femoral condylar notch was evaluated in lateral view. Statistical analyses were used to determine the differences between the two groups. A significant difference in the mean height of the lateral tibial spine, lateral joint space distance, height of the fibular head, and obliquity of the lateral tibial plateau distinguished the two groups (p<0.0001). However, there was no statistical difference in the condylar off sign, squaring of the lateral femoral condyle, cupping of the lateral tibial plateau and lateral femoral condylar notch between groups (n.s.). The cut-off values for the height of the lateral tibial spine (6mm), lateral joint space distance (8mm), height of the fibular head (14.9mm) and obliquity of the lateral tibial plateau (17.6°) were determined. With these cut-off values in diagnosing discoid lateral meniscus, the sensitivity and accuracy of height of the fibular head were 78 and 70%, respectively. Several plain radiographic findings in symptomatic discoid lateral meniscus in children were significantly different from those in normal control. These findings would be helpful in screening tool of discoid lateral meniscus for children. II.

Long-Term Clinical and Radiographic Results of Arthroscopic Reshaping for Symptomatic Discoid Lateral Meniscus in Children (SS-66)

Long-Term Clinical and Radiographic Results of Arthroscopic Reshaping for Symptomatic Discoid Lateral Meniscus in Children (SS-66)

Results of Arthroscopic Partial Meniscectomy for Lateral Discoid Meniscus Tears Associated with New Technique

PurposeTo introduce and evaluate the clinical results of a new arthroscopic technique for partial meniscectomy of symptomatic lateral discoid meniscus using a knife.Materials and MethodsFrom March 2005 to October 2010, 60 knees of 58 patients underwent arthroscopic partial meniscectomies for lateral discoid meniscus. The average age was 28.9 years (range, 12 to 63 years), and average follow-up was 26 months (range, 8 to 72 years). In this procedure, using a No. 11 knife holder inserted through the high far anteromedial portal, a stab incision on the anterior meniscal horn and following piecemeal meniscal excision were made. Clinical results were assessed using the scale of Ikeuchi and Lysholm score.ResultsMeniscus shape was complete in 32 knees (53.3%) and incomplete in 28 knees (46.6%). The shape of tears in complete type lesions was horizontal cleavage in 17 knees (53.1%), flap or complex degenerated tears in 10 knees (31.2%) and radial tears in 5 knees (15.6%). Clinical results assessed using the scale of Ikeuchi were excellent in 38 (63.3%), good in 13 (21.6%), fair in 8 (13.3%) and poor in 1 knee (1.6%). The average Lysholm score was improved from 82.8 preoperatively to 95.4 postoperatively.ConclusionsOur new arthroscopic technique in lateral discoid partial meniscectomy suggests convenient methods and successful clinical results.

Incidence of Bilateral Discoid Lateral Meniscus in An Asian Population: An Arthroscopic Assessment of Contralateral Knees

To investigate the incidence of bilateral discoid lateral meniscus (DLM) and to evaluate the arthroscopic features of lateral meniscus in asymptomatic contralateral knees in an Asian population who presented with symptomatic DLMs. This study prospectively enrolled 52 consecutive patients who underwent arthroscopic procedures for symptomatic DLMs (31 complete and 21 incomplete) and who consented to the examination of the contralateral knee at the time of arthroscopy. Types of DLMs and of meniscus tears were assessed by use of arthroscopic findings. Preoperative and postoperative functional outcomes were evaluated with Lysholm and Tegner activity scores. Arthroscopic examinations showed 21 complete DLMs, 19 incomplete DLMs, 11 normal lateral menisci, and 1 ring-shaped lateral meniscus in contralateral knees. The incidence of bilateral DLM in our study population was 79% (41 of 52 contralateral knees). Furthermore, 65% of patients (34 pairs of knees) had the same DLM types. In addition, 3 pairs of knees with complete DLMs had menisci of different thicknesses. DLM tears were observed in 2 contralateral knees (1 radial and 1 longitudinal) and were treated by partial central meniscectomy. This study provides evidence of the high prevalence of bilateral DLM in an Asian population.

Meniscoplasty for stable osteochondritis dissecans of the lateral femoral condyle combined with a discoid lateral meniscus: a case report.

Osteochondritis dissecans of the lateral femoral condyle is relatively rare, and it is reported to often be combined with a discoid lateral meniscus. Given the potential for healing, conservative management is indicated for stable osteochondritis dissecans in patients who are skeletally immature. However, patients with osteochondritis dissecans of the lateral femoral condyle combined with a discoid lateral meniscus often have persistent symptoms despite conservative management. We present the case of a seven-year-old Korean girl who had osteochondritis dissecans of the lateral femoral condyle combined with a discoid lateral meniscus, which healed after meniscoplasty for the symptomatic lateral discoid meniscus without surgical intervention for the osteochondritis dissecans. In addition, healing of the osteochondritis dissecans lesion was confirmed by an MRI scan five months after the operation. Meniscoplasty can be recommended for symptomatic stable juvenile osteochondritis dissecans of the lateral femoral condyle combined with a discoid lateral meniscus when conservative treatment fails.

Arthroscopic treatment for symptomatic discoid lateral meniscus during childhood

The purpose of this study was to review the operative long-term results of a large cohort of children treated arthroscopically for a symptomatic discoid lateral meniscus. We retrospectively reviewed the arthroscopic procedures performed on 104 knees (97 patients) between 1990 and 2006 to treat symptomatic discoid lateral meniscus in children. The median age at the time of surgery was 8 years (range 2.5-13.9 years). The follow-up was 8.5 ± 2.5 (mean ± SD) years (median 9, range 2-18.5 years). In this series, young children (2-7 years) usually presented complete discoid menisci with deficit in extension and little pain. The meniscal tissue was almost degenerated, and subtotal meniscectomy was performed. Children aged from 8 to 14 years referred to our institute typically presented a symptomatic tear (pain and swelling joint with snap) of a complete or incomplete discoid lateral meniscus, usually pursuant to a trauma. The treatment performed in this group was a partial meniscectomy. Clinical results at long-term follow-up show better results for subtotal meniscectomies than for partial ones. The results showed the long-term efficacy of arthroscopic treatment of a symptomatic discoid lateral meniscus. On the basis of this study, subtotal meniscectomies in younger patients are preferable when meniscal tissue is degenerated. In older children, we recommend to preserve meniscal tissue as much as possible. In younger patients submitted to subtotal meniscectomies, some adaptation of the knee to stress activity may occur. Therapeutic case series, Level IV.

Bilateral Discoid Lateral Meniscus in Knees: Evaluation of the Contralateral Knee in Patients With Symptomatic Discoid Lateral Meniscus

The aim of this study was to analyze, by use of magnetic resonance imaging (MRI), the contralateral discoid lateral meniscus (DLM) status of 33 patients who underwent an operation for a symptomatic DLM. This diagnostic study included 33 consecutive patients who underwent arthroscopic surgery for a unilaterally symptomatic DLM. All patients' contralateral knees were checked with simple radiographs and MRI scans. Knees were also evaluated through physical examinations and a clinical scoring system. On the basis of the MRI findings, DLM was categorized into 3 types: normal type, incomplete discoid type, and complete discoid type. The tear patterns of the lateral menisci as imaged by radiographs and the associated chondral lesions imaged by MRI were analyzed by consensus in the bilateral knees. All but 1 of the contralateral, asymptomatic knees (97%) were diagnosed by MRI to have complete or incomplete DLM. DLMs with tears were found in the contralateral knees in 11 cases (33%), and chondral lesions were found in 4 (12%) of the complete discoid type cases. On radiography, 23 (70%) of the 33 contralateral knees showed characteristic findings of DLM. We found that 29 pairs of knees (88%) had the same lateral meniscus shape on MRI. A κ analysis showed significant and good agreement between the radiographic findings, the tear pattern of the lateral menisci, and the associated chondral lesions on MRI scans in bilateral knees. DLM commonly occurs bilaterally in patients with symptomatic, unilateral surgical DLM, although this finding was applicable only to young, Asian male patients. Characteristic radiographic findings and the MRI findings of symptomatic DLM patients were significantly correlated between both knees. Level I, testing of previously developed diagnostic criteria in a series of consecutive patients with universally applied reference gold standard.

A Novel Magnetic Resonance Imaging Classification of Discoid Lateral Meniscus Based on Peripheral Attachment

Background In the symptomatic discoid lateral meniscus, the effectiveness of preoperative magnetic resonance imaging (MRI) is not well documented. Hypothesis Magnetic resonance imaging classification will provide more information to the surgeon in choosing the appropriate treatment methods with the help of arthroscopic findings. Study design Cohort study (diagnosis); Level of evidence, 2. Methods Sixty-seven patients (82 knees) were reviewed. The preoperative MRI was checked in 76 of 82 knees. The Lysholm and Ikeuchi grading scales were evaluated. Images were analyzed from MRI, and findings were classified into 4 categories: no shift, anterocentral shift, posterocentral shift, and central shift. Tear pattern classifications were based on arthroscopic findings: horizontal tear, peripheral tear, horizontal and peripheral tear, posterolateral corner loss, and others. The correlations between MRI classification tear patterns and surgical methods were analyzed using the chi-square test or the Fisher exact test. The sensitivity, specificity, and accuracy of shift in preoperative MRI–according to the existence of peripheral tear when corroborated with arthroscopy–were also analyzed with the chi-square test. Inter- and intraobserver reliability was statistically analyzed by producing the inter- and intraclass correlation coefficient. Results The mean preoperative Lysholm score was 77.3 (range, 43-97), and the last follow-up Lysholm score had increased to 96.8 (range, 84-100; P <. 001). At last follow-up (100% follow-up), the Ikeuchi grading scale scored 48 knees as excellent, 30 as good, and 4 as fair. According to the MRI classification, 43 knees were no shift; 6, anterocentral shift; 15, posterocentral shift; and 12, central shift. Shift-type knees had a significantly larger number of peripheral tears, and repairs were performed in the shift-type knees (55%) more frequently than in the no-shift-type knees (28%). Among 82 knees, 31 were repaired simultaneously after a central partial meniscectomy. Conclusion Magnetic resonance imaging classification provides more information to surgeons in choosing the appropriate treatment methods, although the final decision regarding procedure is made during arthroscopy after thorough analysis of the tear.

Mini-Arthrotomy for Lateral Discoid Menisci in Children

Long-term results after partial, extended, or complete resection of lateral discoid meniscus in children revealed knee arthritis. The purpose of this study was to evaluate whether the operative approach, arthrotomy or arthroscopy, has an impact on the outcome and the development of arthritis. A retrospective comparison of 2 well matching groups totaling 40 children with symptomatic lateral discoid meniscus (48 knees, mean age 8.9 years, 13 male and 27 female patients). Meniscus resection was performed via mini-arthrotomy in group 1 (n=17 patients, 20 knees) and arthroscopically in group 2 (n=23 patients, 28 knees). In the follow-up (mean 57 months in group 1, 62 months in group 2), functional results indicated a trend to better results in the International Knee Documentation Committee score (P=0.12) and in the Lysholm score for group 1 (P=0.13) but not in the Ikeuchi score (P=0.48). The comparison of the radiographic arthritis grading in the follow-up showed no significant arthritis in either group (P=0.22). The overall complication rate was similar in both groups (2/20, 10% in group 1; 3/28, 12% in group 2). Most likely because of the appropriate visualization of the children's joint and the easier instrumentation, the mini-arthrotomy led to slightly superior results compared with those after arthroscopic resection regarding functional outcome and 5 years after surgery. We can recommend the mini-arthrotomy for the resection of lateral discoid meniscus particularly in young children with narrow joint spaces and for surgeons that are not familiar with arthroscopies of small joints. III (therapeutic study, case series with control group).

Discoid Lateral Meniscus in Children

Limited knee extension is a well-known sign in children with discoid meniscus, but its causative mechanism is controversial. The purpose of this study was to characterize discoid meniscus with this clinical manifestation with a focus on instability of the posterior segment and its morphologic features. The authors retrospectively reviewed magnetic resonance imaging and intraoperative arthroscopic videos of 34 knees in 32 consecutive patients (age range, 4.5-15.0 years) who underwent arthroscopic treatment for symptomatic discoid lateral meniscus. Knees were classified into 2 groups, depending on the presence (n = 19) or absence (n = 15) of an extension block, which was defined as a limitation of knee extension by 10 degrees or more under general anesthesia. Meniscal instability in the posterior segment was determined based on arthroscopic findings, and its correlation with knee extension block was analyzed. Using magnetic resonance imaging, the thicknesses of anterior and posterior segments were measured to assess significance of the thickness differences by a presence of knee extension block and by the posterior segment instability. There were 13 knees with a stable posterior segment and 21 knees with an unstable posterior segment. Meniscal instability in the posterior segment was observed in the knees with a surface tear (n = 12), in a hypermobile posterior rim despite the absence of a surface tear (n = 5), and in knees with a freely movable posterior rim without posterior tibial attachment (n = 4). Knee extension block occurred exclusively in complete type menisci and was significantly correlated with meniscal instability in the posterior segment. Magnetic resonance imaging observations suggested that morphologic features characteristic of thick anterior and thin posterior segments were significantly associated with meniscal instability in the posterior segment. Clinically, knee extension block disappeared in all cases within 4 months of arthroscopic treatment. A redundant anterior segment associated with meniscal instability in the posterior segment is likely to cause limited knee extension in children with discoid lateral meniscus. This correlation mandates that discoid menisci be thoroughly evaluated during arthroscopic treatment to identify any instability that might require stabilization.

Arthroscopic Partial Meniscectomy With Repair of the Peripheral Tear for Symptomatic Discoid Lateral Meniscus in Children: Results of Minimum 2 Years of Follow-up

This study was undertaken to document the clinical results and technical aspects of arthroscopic partial meniscectomy in conjunction with peripheral tear repair for the treatment of symptomatic discoid lateral meniscus in children. From June 1998 to May 2005, the senior author (J.H.A.) performed arthroscopic surgery on 77 children (89 knees) with symptomatic discoid lateral meniscus. Of these patients, we retrospectively studied 23 patients (28 knees) with a peripheral tear that was treated by partial central meniscectomy in conjunction with peripheral suture repair. Mean age at operation was 9.0 years (range, 4 to 15 years), and the mean follow-up period was 50.9 months (range, 24 to 94 months). Arthroscopic findings were categorized into 3 types in terms of peripheral rim stability and tear site: (1) meniscocapsular junction (MC), anterior horn type (MC-A type); (2) MC, posterior horn type (MC-P type); and (3) posterolateral corner (PLC) loss type. These 3 types needed different arthroscopic techniques for saucerization with repair. Clinical results were evaluated using Lysholm knee scores and Hospital for Special Surgery (HSS) scores preoperatively and at final follow-up. All patients were able to return to their previous life activities with little or no limitation, and no reoperation was required after an average follow-up of 51 months. Mean Lysholm knee scores improved from 78.5 (range, 69 to 89) preoperatively to 95.5 (range, 85 to 100) at the final follow-up (P < .0001), and the mean HSS score improved from 80.3 (range, 69 to 89) preoperatively to 95.9 (range, 90 to 100) at the final follow-up (P < .0001). We believe that the described arthroscopic partial meniscectomy in conjunction with the meniscal repair of the peripheral tear are effective for treating children with a symptomatic discoid lateral meniscus. Level IV, therapeutic case series.

Arthroscopic Partial Meniscectomy with Repair of the Peripheral Tear for Symptomatic Discoid Lateral Meniscus in Children: Results of Minimum 2 Years Follow-up (SS-32)

Arthroscopic Partial Meniscectomy with Repair of the Peripheral Tear for Symptomatic Discoid Lateral Meniscus in Children: Results of Minimum 2 Years Follow-up (SS-32)

Arthroscopic treatment of symptomatic discoid lateral meniscus in a 26-month-old girl

Discoid lateral meniscus is a well-documented pathology, but symptomatic discoid lateral meniscus in a very young child and arthroscopic management are extremely rarely reported. We report a case of symptomatic discoid lateral meniscus in a 26-month-old girl who showed limping and extension loss after a minor trauma. Physical examination revealed clicking and 10° terminal extension loss, which was suggestive of the torn discoid meniscus. Magnetic resonance imaging showed discoid lateral meniscus with intrameniscal tear. Treatment consisted of arthroscopic one-piece excision technique with conventional arthroscopic instrument and a No. 11 blade. A good subjective and objective functional outcome has been obtained after 35 months of follow-up evaluation.

Arthroscopic meniscectomy for discoid lateral meniscus in children and adolescents: 4.5 year follow-up.

We retrospectively reviewed the 4.5 year (range, 21-88 months) follow-up results of arthroscopic partial meniscectomies performed in 11 knees between 1994 and 2000 to treat a symptomatic discoid lateral meniscus. The average age at surgery was 11.5 years (range, 5-17 years). All except one of the discoid menisci were of a complete type, and all except three were torn menisci. At the latest follow-up examination, the result was excellent for nine knees, and good for two; no degenerative changes were evident on the roentgenograms. Arthroscopic partial meniscectomy should be the treatment of choice for the complete type symptomatic lateral discoid meniscus, even if it is intact. Preoperative lack of the knee extension requires a gentle rehabilitation program postoperatively.

Paper #172 Clinical results after arthroscopic meniscectomy for discoid lateral menisci

The clinical results after meniscectomy for the discoid meniscus has been variable especially in the long term follow up. We reviewed the cases of one hundred nineteen knees with symptomatic discoid lateral meniscus who underwent total, subtotal or partial arthroscopic meniscectomy between January 1990 and December 1999. The mean age at surgery was 30.5 years old (range: three to sixty years) at the time of operation. Preoperative duration of symptoms was 16.8 months and average duration of follow up was 60.1 months. At arthroscopy, 91 menisci were complete, 28 menisci were incomplete type. Patients were divided into three groups based on the type of surgery. Arthroscopic total meniscectomy was underwent in 47 cases of knee, subtotal meniscectomy in 21 cases and partial meniscectomy in 51 cases. On the basis of Ikeuchi grading system, 34 knees were graded as excellent, 62 knees were rated as good, 22 knees were rated as fair and 1 knee as poor. Longer duration of symptom and older age had a statistically significant higher risk of developing chondromalacia in knee joint (P = 0.001). But no correlation was found between symptom duration and type of meniscal lesion. In patients who had had total meniscectomy for the complete type of lesion and partial meniscectomy for the incomplete type, results were satisfactory respectively in cases of less than 5 years follow-up. We found unsatisfactory results with significant preoperative chondromalacia and longer follow up. The clinical results after meniscectomy for the discoid meniscus has been variable especially in the long term follow up. We reviewed the cases of one hundred nineteen knees with symptomatic discoid lateral meniscus who underwent total, subtotal or partial arthroscopic meniscectomy between January 1990 and December 1999. The mean age at surgery was 30.5 years old (range: three to sixty years) at the time of operation. Preoperative duration of symptoms was 16.8 months and average duration of follow up was 60.1 months. At arthroscopy, 91 menisci were complete, 28 menisci were incomplete type. Patients were divided into three groups based on the type of surgery. Arthroscopic total meniscectomy was underwent in 47 cases of knee, subtotal meniscectomy in 21 cases and partial meniscectomy in 51 cases. On the basis of Ikeuchi grading system, 34 knees were graded as excellent, 62 knees were rated as good, 22 knees were rated as fair and 1 knee as poor. Longer duration of symptom and older age had a statistically significant higher risk of developing chondromalacia in knee joint (P = 0.001). But no correlation was found between symptom duration and type of meniscal lesion. In patients who had had total meniscectomy for the complete type of lesion and partial meniscectomy for the incomplete type, results were satisfactory respectively in cases of less than 5 years follow-up. We found unsatisfactory results with significant preoperative chondromalacia and longer follow up.