Treatment Of Discoid Meniscus Research Articles

Operative Treatment of Discoid Meniscus

The discoid meniscus (DM) is a congenital variant of the normal crescent-shaped meniscus, resulting in hypertrophic meniscal tissue, altered collagen structure, decreased peripheral vascularity, and an atypical shape. Although significant advances have been made in the operative treatment of DM, there still needs to be more clarity regarding best practices. The following review aims to summarize current knowledge to help practitioners improve their approach when dealing with patients with DM.

Anterior Cruciate Ligament Ruptured Concomitant Meniscus Discoid in Young Patient: A Rare Case Report

Background: Abnormalities of the human meniscus, including discoid meniscus, double-layered meniscus, and ring-shaped meniscus, have been reported. The prevalence of discoid meniscus is extremely rare, with an incidence of 0.9%－2.4% in the Asian population. Traditionally, discoid meniscus concomitant anterior cruciate ligament (ACL) ruptures are extremely rare cases. The aim of this study is to discuss a rare case to provide diagnosis and management properly by using arthroscopy.Case Presentation: A 21-year-old male Balinese, complained of pain in his right knee after fast walking for two months and an unstable knee in the past 1 year ago. On physical examination, the range of motion was limited due to the pain for flexion of more than 90°. Special tests such as Lachman test positive, and Anterior drawer test positive. The patient had medial joint line tenderness, and a McMurray test elicited pain on the medial joint line. Meanwhile, an MRI examination of the right knee showed a discoid medial meniscus with a horizontal cleavage tear and a discoid lateral meniscus with an incomplete tear. We performed a partial meniscectomy of the incomplete discoid medial meniscus and resection of the pathologic medial patellar plica. We performed surgical reconstruction of the ACL ruptured after the meniscus was repaired.Results: We presented a 21-year-old male with discoid meniscus concomitant ACL rupture to his right knee. After the patient was performed with partial meniscectomy of the incomplete discoid medial meniscus and resection of pathologic medial patellar plica following surgical reconstruction of the ACL ruptured. The patient had no limitation of motion or pain 1 year after the operation and he had no complaints and was satisfied with the result by radiograph.Conclusion: We concluded that This rare case of medial discoid meniscus concomitant with the ACL rupture must be reconstructed. The treatment of discoid meniscus should consider its tear pattern and whether it is symptomatic. With the development of arthroscopic techniques, the treatment of discoid meniscus has gradually changed from total meniscectomy or partial meniscectomy.Keywords: anterior cruciate ligament, meniscus, discoid, knee, arthroscopy.Correspondence: I Gusti Ngurah Wien Aryana. Department of Orthopaedic & Traumatology, General Central Hospital of I.G.N.G Ngoerah Central Hospital/ Faculty of Medicine, Udayana University, Bali, Indonesia. Email: wienaryanaortho@gmail.com. Mobile: +62811-385-263.Indonesian Journal of Medicine (2023), 08(03): 317-324https://doi.org/10.26911/theijmed.2023.08.03.09

Higher Rates of Mensical Repair and Rim Preservation in Younger Patients with Discoid Lateral Menisci

Background:Management of discoid meniscus in pediatric patients requires understanding of the presentation, associated risks, and appropriate techniques. Surgical treatment consists of saucerization, meniscus repair, meniscocapular stabilization, and, periodically, subtotal meniscectomy. The type of meniscal treatment is commonly determined during arthroscopy. Thus, surgeons, patients, and their parents/guardians must be prepared for a variety of surgical options.Hypothesis/Purpose:To compare intraoperative arthroscopic findings and treatment of discoid meniscus across pediatric age groups in a large multicenter quality improvement registry.Methods:A multi-center quality improvement registry (16 institutions, 26 surgeons) monitoring the safety of discoid meniscus surgery was reviewed. Audit processes using CPT codes were designed to ensure that all consecutive cases from 2018-2020 were prospectively entered on patients <19 years old into a HIPAA-compliant electronic platform. Patients were grouped into five groups based on age at time of surgery (<7, 7-10, 11-13, 14-16, >16). Demographic characteristics, discoid type, presence and type of tear, peripheral rim instability, repair technique, and partial meniscectomy/debridement beyond saucerization were reviewed. Chi-Square or Fisher’s exact tests were used for categorical comparisons and a Kruskal-Wallis test for continuous comparisons.Results:274 patients were identified (mean age 12.4 years, range 3-18; 47.3% females). Complete discoid meniscus and peripheral rim instability were found to be more prevalent in younger age groups (Table 1). Peripheral rim instability was noted in 55.5% of cases, most commonly in the posterior horn (24.8%). While a focal region of instability was most common, the youngest age group was more likely to have either multifocal instability or no instability. Repair was conducted more commonly in the younger cohorts, with a significant decrease in repair percentage (p=0.008) per age group. All-inside was the most common repair technique in all age groups. Partial meniscectomy/debridement beyond saucerization occurred more frequently in older age groups than younger age groups (p=.0002), including 38.4% of cases in the oldest age group (Table 2).Conclusion:Younger patients experienced a greater incidence of complete discoid menisci and meniscus repair in this age group and was more likely to have more than one area of rim instability. However, when meniscal resection beyond a saucerization was required, this was more likely to occur in older patients.Table 1.Age-Related Comparison of Discoid Meniscal Presentation and TreatmentTable 2.Incidence of Additional Meniscal Resection Beyond Saucerization

Discoid meniscus (author's transl)

The discoid meniscus is a developmental varient which can produce symptoms resembling those of a meniscus lesion. Two cases are described and the literature is reviewed. The clinical features, diagnosis, pathogenesis and treatment of discoid meniscus is discussed.