1
|
Mitra M, Lee YHD. Ring-Shaped Meniscus, MRI Features, and Diagnosis: A Report of 2 Cases. JBJS Case Connect 2023; 13:01709767-202309000-00089. [PMID: 37733915 DOI: 10.2106/jbjs.cc.23.00224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
CASE A ring-shaped meniscus (RSM) is a rare malformation of debatable origin usually occurring on the lateral meniscus. Here, we present 2 cases of RSM with differing etiologies and discuss the current literature on the topic. These reports may help with the identification of RSMs in the future and assist in understanding the true etiopathogenesis of individual cases. CONCLUSION These 2 cases exemplify the variation in presentations of ring-shaped menisci and their radiological features on both x-ray and magnetic resonance imaging. This reinforces the idea that there may be both a congenital and an iatrogenic etiology to this rare condition.
Collapse
Affiliation(s)
| | - Yee Han Dave Lee
- Head Division Sports Shoulder Elbow Surgery, National University Hospital, Singapore
| |
Collapse
|
2
|
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.
Collapse
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.
| |
Collapse
|
3
|
Iqbal A, McLoughlin E, Botchu R, James SL. The ring-shaped meniscus: a case series demonstrating the variation of imaging appearances on MRI. Skeletal Radiol 2020; 49:281-289. [PMID: 31363822 DOI: 10.1007/s00256-019-03277-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/05/2019] [Accepted: 07/04/2019] [Indexed: 02/02/2023]
Abstract
The ring-shaped meniscus (RSM) is a rare meniscal variant in which there is an intermeniscal bridge between the anterior and posterior horns of the meniscus, thus forming a complete ring. The lateral meniscus is more commonly involved than the medial meniscus. Distinguishing an RSM from a bucket handle tear (BHT) with a displaced fragment in the intercondylar notch is challenging and there are reports of negative arthroscopies for suspected BHTs. There are many reports of symptomatic and asymptomatic lateral RSMs diagnosed on MRI in the literature. We report a series of RSMs in six patients, which includes MRI descriptions of two cases of medial RSM and a case of bilateral lateral RSM, which were diagnosed on MRI and have never previously been reported. This study will also describe the various imaging features of a RSM that distinguish it from a displaced BHT. We will also discuss associated rare malformations encountered in our study, such as hypoplastic anterior cruciate ligament and the anomalous insertion of the popliteus tendon onto the posterior horn of a lateral RSM.
Collapse
Affiliation(s)
- A Iqbal
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, UK
| | - E McLoughlin
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, UK
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, UK.
| | - S L James
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, UK
| |
Collapse
|
4
|
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.
Collapse
|
5
|
Lin Z, Huang W, Ma L, Chen L, Huang Z, Zeng X, Xia H, Zhang Y. Kinematic features in patients with lateral discoid meniscus injury during walking. Sci Rep 2018; 8:5053. [PMID: 29567979 PMCID: PMC5864959 DOI: 10.1038/s41598-018-22935-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 02/27/2018] [Indexed: 12/05/2022] Open
Abstract
At present, there few studies on the kinematic features of lateral discoid meniscus injury. In this study, a motion capture system was used to investigate the motion characteristics of knees with lateral discoid meniscus after injury, and the differences between the knees with lateral meniscus and intact knees were compared. Fourteen patients diagnosed with unilateral lateral discoid meniscus injury, fourteen patients diagnosed with unilateral lateral meniscus injury, and fourteen normal subjects with healthy knees were recruited and grouped. Through kinematic gait analysis, it was found that the subjects in the two groups with meniscus injuries exhibited significantly smaller ranges of rotation and translation than those with healthy knees on the sagittal, coronal, and horizontal planes, but not in proximal-distal translation. Maximum lateral tibial translation and maximum internal tibial rotation in the knees with lateral discoid meniscus injury were significantly decreased compared to those with lateral meniscus injury. The results show that the kinematic features of knees with lateral discoid meniscus injury are statistically different than those of healthy knees and knees with lateral meniscus injury. This study provides an important reference for the dynamic function of knees with lateral discoid meniscus injury.
Collapse
Affiliation(s)
- Zefeng Lin
- Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, 510010, China.,Guangdong Key Laboratory of Orthopedic Technology and Implant Materials, Guangzhou, 510010, China
| | - Wenhan Huang
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Limin Ma
- Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, 510010, China.,Guangdong Key Laboratory of Orthopedic Technology and Implant Materials, Guangzhou, 510010, China
| | - Lingling Chen
- Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, 510010, China.,Southern Medical University, Guangzhou, 510515, China
| | - Zhiqiang Huang
- Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, 510010, China.,Guangzhou Medical University, Guangzhou, 511436, China
| | - Xiaolong Zeng
- Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, 510010, China.,Guangzhou Medical University, Guangzhou, 511436, China
| | - Hong Xia
- Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, 510010, China. .,Guangdong Key Laboratory of Orthopedic Technology and Implant Materials, Guangzhou, 510010, China. .,Southern Medical University, Guangzhou, 510515, China.
| | - Yu Zhang
- Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, 510010, China. .,Guangdong Key Laboratory of Orthopedic Technology and Implant Materials, Guangzhou, 510010, China. .,Southern Medical University, Guangzhou, 510515, China.
| |
Collapse
|
6
|
Fujii M, Furumatsu T, Miyazawa S, Tanaka T, Inoue H, Kodama Y, Ozaki T. Formation of ring-shaped lateral meniscus following anterior cruciate ligament reconstruction: A case report. Int J Surg Case Rep 2017; 31:229-232. [PMID: 28189986 PMCID: PMC5304237 DOI: 10.1016/j.ijscr.2017.01.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/23/2017] [Accepted: 01/23/2017] [Indexed: 11/30/2022] Open
Abstract
There were no meniscal anomalies such as discoid meniscus and ring-shaped meniscus at the first surgery. Postoperative MRI showed a ring-shaped lateral meniscus. On second-look arthroscopy, there was a meniscus-like tissue formation that connected the anterior horn to the posterior horn of the lateral meniscus at the lateral intercondylar tubercle. The ring-shaped meniscus-like tissue was spontaneously formed after ACL reconstruction.
Introduction We presented the first case in the literature of inter-horn bridge formation involved in ring-shaped lateral meniscus after anterior cruciate ligament (ACL) reconstruction. Presentation of case A 22-year-old man underwent anatomic double-bundle ACL reconstruction using semitendinosus tendon autograft. At the surgery, the lateral meniscus showed a normal appearance without meniscal tears and had no instability. There were no meniscal anomalies such as discoid meniscus and ring-shaped meniscus. Magnetic resonance image examination was performed before second-look arthroscopy at 1 year postoperatively. A coronal plane showed a small triangular fragment located at the medial border of the lateral tibial plateau. An axial plane demonstrated a ring-shaped lateral meniscus. On second-look arthroscopy, there was a meniscus-like tissue formation that connected the anterior horn to the posterior horn of the lateral meniscus at the lateral intercondylar tubercle. Discussion Ring-shaped meniscus is an extremely rare malformation of the meniscus. Our hypothesis was that drilling debris and remaining remnant of ACL might induce a scar tissue formation. Conclusion This is the first case in the literature of inter-horn bridge formation involved in ring-shaped lateral meniscus following ACL reconstruction.
Collapse
Affiliation(s)
- Masataka Fujii
- Department of Orthopaedic Surgery, Okayama University, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
| | - Shinichi Miyazawa
- Department of Orthopaedic Surgery, Okayama University, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Takaaki Tanaka
- Department of Orthopaedic Surgery, Sumitomo Besshi Hospital, Japan
| | - Hiroto Inoue
- Department of Orthopaedic Surgery, Okayama University, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Yuya Kodama
- Department of Orthopaedic Surgery, Okayama University, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| |
Collapse
|
7
|
Kim JG, Han SW, Lee DH. Diagnosis and Treatment of Discoid Meniscus. Knee Surg Relat Res 2016; 28:255-262. [PMID: 27894171 PMCID: PMC5134787 DOI: 10.5792/ksrr.16.050] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 10/23/2016] [Accepted: 10/24/2016] [Indexed: 10/24/2022] Open
Abstract
There is a greater incidence of discoid meniscus in Asian countries than in Western countries, and bilateral discoid menisci are also common. The discoid meniscus may be a congenital anomaly, and genetics or family history may play a role in the development of discoid menisci. Because the histology of discoid meniscus is different from that of normal meniscus, it is prone to tearing. Individuals with a discoid meniscus can be asymptomatic or symptomatic. Asymptomatic discoid menisci do not require treatment. However, operative treatment is necessary if there are symptoms. Total meniscectomy leads to an increased risk of osteoarthritis. Therefore, total meniscectomy is generally reserved for rare unsalvageable cases. Partial meniscectomy (saucerization) with preservation of a stable peripheral rim combined with or without peripheral repair is effective, and good short-, mid-, and long-term clinical results have been reported.
Collapse
Affiliation(s)
- Jae-Gyoon Kim
- Department of Orthopedic Surgery, Korea University Ansan Hospital, Ansan, Korea
| | - Seung-Woo Han
- Department of Orthopedic Surgery, Korea University Ansan Hospital, Ansan, Korea
| | - Dae-Hee Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
8
|
Abstract
Discoid lateral meniscus is a common abnormal meniscal variant in children. Detailed history and physical examination combined with an MRI of the knee predictably diagnose a discoid meniscus. The clinical presentation varies from being asymptomatic to snapping, locking, and causing severe pain and swelling of the knee. Because of the pathologic anatomy and instability, discoid menisci are more prone to tearing. Treatment options for symptomatic patients vary based on the type of anomaly, the age of the patient, stability, and the presence or absence of a tear. Improvements in arthroscopic equipment and technique have resulted in good to excellent short-term outcomes for saucerization and repair.
Collapse
|
9
|
|