Management of Long-Term Complications in the Setting of Lateral Meniscal Deficiency After Saucerization of a Discoid Lateral Meniscus in an Adolescent Patient: A Case Report and Review of the Literature

Variation in Arthroscopic Treatment of Discoid Lateral Meniscus and Postoperative Restrictions in Children: Results of a Multicenter Meniscus Study Group Survey

Background

Because of congenital abnormal collagenous structures and peripheral attachments, discoid lateral meniscus (DLM) is often associated with tears and instability and a risk of premature compartmental articular degeneration. Typically, surgery is indicated for symptomatic patients. Several surgical techniques have been described in the literature, but no studies have examined surgeon variation.

Purpose

To determine the intersurgeon agreement for DLM surgical planning and postoperative restriction after arthroscopic assessment.

Study Design

Cross-sectional study.

Methods

Sixteen orthopaedic surgeons from an international pediatric meniscus study group were shown 4 different videos of a DLM arthroscopic procedure. Each surgeon completed a survey for each arthroscopic video. The survey included questions about operative planning, such as peripheral rim preservation, repair and stabilization technique, and postoperative restrictions. Descriptive statistics were used to characterize the variables collected.

Results

One of the 4 arthroscopic videos showed a complete discoid meniscus with no instability or tearing. For this specific meniscus, consensus was generally good, with 87.5% to 93.8% agreement for all the categories, except peripheral rim preservation, with 31.3% agreement. However, for the other 3 videos with tears and/or instability, consensus was generally low. Depending on the categories, the highest percentage of intersurgeon agreement varied between 25.0% and 62.5%, while being >50% only 2 of 27 times.

Conclusion

Agreement regarding the surgical technique and postoperative rehabilitation among surgeons with experience in the treatment of DLM is poor in the event of tears and instability, which represent the greatest technical challenges with the most significant functional effect. Given the relative rarity of the condition and the implications on a child's long-term joint health, prospective, comparative multicenter studies regarding treatment algorithms and outcomes are warranted.

Saucerization of complete discoid lateral meniscus is associated with change of morphology of the lateral femoral condyle and tibial plateau

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.