1
|
Utility of Adult-Based Discoid Lateral Meniscus Diagnostic Criteria in a Pediatric Population. Orthop J Sports Med 2024; 12:23259671241239036. [PMID: 38617887 PMCID: PMC11010757 DOI: 10.1177/23259671241239036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 10/01/2023] [Indexed: 04/16/2024] Open
Abstract
Background Commonly cited discoid lateral meniscus (DLM) imaging definitions are based on adult magnetic resonance imaging (MRI) measurements. This pathology commonly presents in pediatric populations; however, whether accepted adult measurements reliably apply to children and adolescents is unknown. Purpose/Hypothesis This purposes of the study were to determine (1) the utility of applying adult-accepted MRI definitions of DLM to pediatric patients, (2) whether sex differences affect the applicability of the criteria, and (3) whether MRI magnet strength and/or tear presence affect MRI measurements for diagnosing DLM in pediatric patients. It was hypothesized that MRI criteria for DLM would be similar in adults and pediatric patients. Study Design Case series; Level of evidence, 4. Methods A total of 100 consecutive MRIs from pediatric patients with DLM were evaluated, with 91 scans included. Two study authors independently reviewed the MRIs, evaluating meniscal height and width on sagittal and coronal images, "bow tie signs" on sagittal images, tibial sagittal and coronal width, and tear presence. For analysis, MRI magnet strength was dichotomized into high (>1.5 T) and low (<1.5 T) groups. Results The mean age of the patients at MRI evaluation was 12.3 ± 3.4 years; 51% of the patients were male, and 56% of the scans were of left knees. Included patients with DLM showed a mean of 3.68 bow tie signs, a sagittal total anterior to posterior meniscal width/tibial width ratio of 73%, a coronal meniscal width/tibial width ratio of 30%, and a coronal, transverse width of the lateral meniscus at the midportion of the meniscal body of 20.6 ± 7.7 mm. The MRI tesla strength of the images included in this study ranged from 0.3 to 3. It was determined that high- versus low-resolution MRI scans did not affect the inter- or intraobserver reliability of the MRI measurments (P > .05). However, several measurements showed improved intraclass correlation coefficients with increased tesla strength. Conclusion This study confirms that pediatric patients with DLM, diagnosed by board-certified pediatric sports medicine orthopaedic surgeons, have measurements on MRI consistent with adult DLM diagnostic criteria. This finding held true regardless of sex or MRI tesla strength. Pediatric patients with DLM had >3 bow tie signs, >70% sagittal tibial plateau coverage, >14 mm coronal width, and >20% coronal tibial plateau coverage on MRI.
Collapse
|
2
|
Patient-Reported Outcomes After Surgically Treated Anterior Horn Tears in the Pediatric Discoid Meniscus. Orthop J Sports Med 2024; 12:23259671241232308. [PMID: 38571486 PMCID: PMC10989054 DOI: 10.1177/23259671241232308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 08/21/2023] [Indexed: 04/05/2024] Open
Abstract
Background As a subset of symptomatic discoid lateral meniscal (DLM) tears, anterior horn (AH) meniscal tears are not well studied in the pediatric population. There are even fewer studies reporting patient-reported outcomes after surgical treatment of AH tears in DLM. Purpose To compare reported outcomes after surgical treatment of DLM tears involving the AH versus other locations in pediatric patients. Study Design Cohort study; Level of evidence, 3. Methods A retrospective review of prospectively collected patient data between 2013 and 2020 was conducted. Patients aged <18 years who underwent arthroscopic treatment of a symptomatic DLM were included. Pathology was classified as tears of the AH or tears not involving the anterior horn (NAH). Demographic data along with patient-reported outcome scores (Pediatric International Knee Documentation Committee [Pedi-IKDC] and Patient Assessment Questionnaire [PAQ]) were collected preoperatively through 24 months of follow-up. Results A total of 41 patients were included (median age, 12.9 years; range, 7-17 years; 32% female, 68% male). The mean follow-up time for was 25 months (range, 8-58 months). There were 17 (41%) patients in the AH group and 24 (59%) patients in the NAH group. Of the AH group, 16 (94%) were treated with meniscal repair (vs menisectomy), while 19 (79%) of the NAH group were treated with meniscal repair. All patients achieved significant pre- to postoperative improvement on both the Pedi-IKDC and the PAQ. At 24-month follow-up, there were no differences between the AH and NAH groups on the Pedi-IKDC (92.51 vs 89.72; P = .18) or the PAQ (2.57 vs 2.61; P = .06). Conclusion Patients who underwent meniscal repair for AH DLM reported positive postoperative outcomes.
Collapse
|
3
|
Discoid Double-layered Lateral Meniscus: A Case Report. J Orthop Case Rep 2024; 14:152-155. [PMID: 38560329 PMCID: PMC10976528 DOI: 10.13107/jocr.2024.v14.i03.4324] [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: 12/24/2023] [Revised: 01/02/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Abnormalities of the double-layered meniscus are rare and can be difficult to diagnose. The main pathology in this abnormality, which is predominantly seen in the lateral compartment, is an accessory meniscus lying over the normal meniscus. Anatomically, this structure can appear in different forms. Although other meniscal abnormalities associated with a double-layered meniscus have been reported, this case presents a previously undescribed type in the literature. Case Report A 12-year-old girl presented to our clinic with complaints of knee locking and pain. When the patient underwent arthroscopy, an accessory incomplete discoid meniscus was found overlying the normal lateral meniscus. We performed an excision of the upper accessory meniscus and the patient had no problems during 3 years of follow-up after surgery. Conclusion Abnormalities of the lateral meniscus are rare and can be difficult to diagnose. In cases where we suspect a meniscal abnormality, a proper arthroscopic examination should be performed and if a discoid meniscus is seen, it should be considered that this may be a double-layered meniscus.
Collapse
|
4
|
[Medial discoid meniscus in a pediatric patient. Case report and review of the literature]. ACTA ORTOPEDICA MEXICANA 2024; 38:52-56. [PMID: 38657152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Discoid meniscus is a congenital morphological variant of the meniscus, which tends to occur more frequently in its lateral form than in the medial form. This anomaly is characterized by central hypertrophy of the meniscus and a larger diameter than the normal meniscus, resulting in an abnormal shape and greater coverage of the tibial plateau. The clinical presentation of this condition varies depending on the stability of the meniscus. In pediatric patients, in particular, it is common to experience progressive and atraumatic symptoms, such as pain and limited mobility. Diagnosis is based on imaging studies, with magnetic resonance imaging being the preferred tool, where the "bowtie sign" is a classic finding. Surgery is recommended for symptomatic patients, with a focus on preserving the peripheral portion of the meniscus. Saucerization is the most commonly used technique, followed by stability assessment to determine if additional procedures are required. In this case, a 9-year-old patient with a medial discoid meniscus presented symptoms following trauma. Despite this atypical presentation, a successful outcome was achieved through arthroscopic surgery, underscoring the importance of accurate diagnosis and proper management of this condition in pediatric patients. Understanding the anatomical and pathophysiological characteristics of the discoid meniscus is essential for an effective therapeutic approach.
Collapse
|
5
|
Relationship Between Age and Pathology With Treatment of Pediatric and Adolescent Discoid Lateral Meniscus: A Report From the SCORE Multicenter Database. Am J Sports Med 2023; 51:3493-3501. [PMID: 37899536 PMCID: PMC10623608 DOI: 10.1177/03635465231206173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 07/20/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Surgical treatment options of discoid lateral meniscus in pediatric patients consist of saucerization with or without meniscal repair, meniscocapular stabilization, and, less often, subtotal meniscectomy. PURPOSE To describe a large, prospectively collected multicenter cohort of discoid menisci undergoing surgical intervention, and further investigate corresponding treatment of discoid menisci. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A multicenter quality improvement registry (16 institutions, 26 surgeons), Sports Cohort Outcomes Registry, was queried. Patient characteristics, discoid type, presence and type of intrasubstance meniscal tear, peripheral rim instability, repair technique, and partial meniscectomy/debridement beyond saucerization were reviewed. Discoid meniscus characteristics were compared between age groups (<14 and >14 years old), based on receiver operating characteristic curve, and discoid morphology (complete and incomplete). RESULTS In total, 274 patients were identified (mean age, 12.4 years; range, 3-18 years), of whom 55.6% had complete discoid. Meniscal repairs were performed in 55.1% of patients. Overall, 48.5% of patients had rim instability and 36.8% had >1 location of peripheral rim instability. Of the patients, 21.5% underwent meniscal debridement beyond saucerization, with 8.4% undergoing a subtotal meniscectomy. Patients <14 years of age were more likely to have a complete discoid meniscus (P < .001), peripheral rim instability (P = .005), and longitudinal tears (P = .015) and require a meniscal repair (P < .001). Patients ≥14 years of age were more likely to have a radial/oblique tear (P = .015) and require additional debridement beyond the physiologic rim (P = .003). Overall, 70% of patients <14 years of age were found to have a complete discoid meniscus necessitating saucerization, and >50% in this young age group required peripheral stabilization/repair. CONCLUSION To preserve physiological "normal" meniscus, a repair may be indicated in >50% of patients <14 years of age but occurred in <50% of those >14 years. Additional resection beyond the physiological rim may be needed in 15% of younger patients and 30% of those aged >14 years.
Collapse
|
6
|
MRI Analysis of Knee Bony Morphology Variations in Children and Adolescents With Lateral Discoid Meniscus Compared With Asymptomatic Healthy Controls. Am J Sports Med 2023; 51:3190-3196. [PMID: 37641845 DOI: 10.1177/03635465231190792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND Lateral discoid meniscus accounts for most meniscal tears in children 10 years of age and younger. The role of bony morphology in discoid meniscus has been previously studied in a limited capacity using radiographs. PURPOSE To use magnetic resonance imaging to measure features of the femoral condyles and tibial plateaus in patients with discoid meniscus to assess potential determinants of symptoms and subsequent surgery and to compare with matched controls to investigate age-related changes in bony features. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS After institutional review board approval, detailed morphology of the femoral condyles and tibial plateau was measured in 177 patients (3-18 years of age; 56% female) with confirmed lateral discoid meniscus. Measurements from 269 participants (3-18 years of age; 55% female) with asymptomatic knees were used as controls. Two-way analysis of variance with Holm-Šídák post hoc was used to compare measurements between discoid menisci and matched controls. Independent t tests were used to compare aspects of bony morphology within the discoid meniscus cohort. RESULTS Compared with controls, patients with a lateral discoid meniscus had a larger bicondylar width and notch width (7- to 10-year-old and 15- to 18-year-old age groups; P < .05), larger tibial plateau width (11- to 14-year-old and 15- to 18-year-old age groups; P < .001), and smaller lateral (P < .02) and coronal (P < .02) tibial slopes across all age groups. Among patients with a discoid meniscus, larger bicondylar width, larger tibial plateau width, larger notch width, and a flatter lateral femoral condyle were associated with pain (P < .005) and lateral meniscal tears (P < .02). Larger notch width and notch width index were also associated with subsequent surgery (P < .05). CONCLUSION There are clinically significant abnormalities in bony morphology in patients with a discoid meniscus, including larger femoral condyles and tibial plateaus and a flatter tibial plateau. Additionally, femoral size, femoral curvature, and tibial plateau size may influence the likelihood of knee pain, meniscal tear, and need for surgery. These findings highlight the importance of bony morphology in discoid meniscus pathophysiology in children and adolescents. Such measurements may also aid radiographic detection of discoid meniscus and guide decisions regarding the timing of potential surgical intervention.
Collapse
|
7
|
Comparison between conservative and prophylactically concurrent meniscoplasty on the asymptomatic knee in children with bilateral DLM. Medicine (Baltimore) 2023; 102:e34226. [PMID: 37390247 PMCID: PMC10313277 DOI: 10.1097/md.0000000000034226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/15/2023] [Indexed: 07/02/2023] Open
Abstract
This retrospective study aimed to compare the effectiveness between concurrent meniscoplasty and conservative management on the asymptomatic side in children with unilaterally symptomatic bilateral discoid lateral meniscus operated on the symptomatic side in a tertiary level of clinical care. Patients aged under 14 with unilaterally symptomatic bilateral discoid lateral meniscus underwent arthroscopic meniscoplasty were eligible. Patients were either underwent meniscoplasty on the symptomatic side, with the asymptomatic side conservatively treated (group 1) or underwent meniscoplasty on both sides concurrently (group 2). Functional outcomes were evaluated using the Lysholm score and Ikeuchi score. Relative cost collected through the hospital data was applied by the Kruskal-Wallis test. The occurrence of symptoms was applied by the Kaplan-Meier model. A total of 50 patients (39 female and 11 male) were eligible. For the average Lysholm scores, groups 1 and 2 of the previously asymptomatic side were 90.86 ± 8.25 and 92.62 ± 8.68. For the symptomatic side, the Lysholm scores were 91.38 ± 8.90 and 95.71 ± 7.45. For the average cost of treatment, a significant difference was discovered between group 1 and 2 (P < .0001). The Kaplan-Meier survival analysis of the occurrence of symptoms showed no statistical difference between the 2 groups (P = .162), and the terminal survival rates in the 2 groups were 86.2% and 81.0%, respectively. Conservative treatment reached the same clinical outcomes as the concurrent meniscectomy, with a potential of longer mean survival time and lower demand of cost in treatment.
Collapse
|
8
|
Reliability of MRI Interpretation of Discoid Lateral Meniscus: A Multicenter Study. Orthop J Sports Med 2023; 11:23259671231174475. [PMID: 37275780 PMCID: PMC10236248 DOI: 10.1177/23259671231174475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/26/2023] [Indexed: 06/07/2023] Open
Abstract
Background Discoid lateral meniscus (DLM) has a varied and complex morphology that can be challenging to assess and treat. Preoperative magnetic resonance imaging (MRI) is frequently used for diagnosis and surgical planning; however, it is not known whether surgeons are reliable and accurate in their interpretation of MRI findings when defining the pathomorphology of DLM. Hypothesis Surgeons experienced in treating DLM are able to reliably interpret DLM pathology using MRI. Study Design Cohort study (diagnosis); Level of evidence, 3. Methods Knee MRI scans from 44 patients (45 knees) were selected from a pool of surgically treated patients with DLM. Five reviewers (fellowship-trained pediatric sports medicine surgeons) performed independent review of each MRI scan using the PRiSM Discoid Meniscus Classification. Inter- and intraobserver reliability of the rating factors-primary (width, height, presence of peripheral instability or tear) and secondary (location of instability or tear, tear type)-was assessed using the Fleiss κ coefficient, designed for multiple readers with nominal variables (fair reliability, 0.21-0.40; moderate, 0.41-0.60; substantial, 0.61-0.80; excellent, 0.81-1.00). Reliability is reported as κ (95% CI). Results Interobserver reliability in assessing most primary and secondary characteristics ranged from substantial (meniscal width) to moderate (peripheral instability, anterior instability, posterior instability, and posterior tear). Intraobserver reliability for most characteristics ranged from substantial (peripheral instability, presence of tear, anterior instability, posterior instability, and posterior tear) to moderate (meniscal width, anterior tear, and tear type). Notable exceptions were presence of tear, anterior tear, and tear type-all with fair interobserver reliability. Height had poor interobserver reliability and fair intraobserver reliability. Conclusion Orthopaedic surgeons reliably interpret MRI scans using the PRiSM Discoid Meniscus Classification for the majority of DLM characteristics but vary in their assessment of height and presence and type of tear. MRI evaluation may be helpful to diagnose discoid by width and identify the presence of instability: 2 major factors in the decision to proceed with surgery. Arthroscopic evaluation should be used in conjunction with MRI findings for complete DLM diagnosis.
Collapse
|
9
|
Medial Discoid Meniscus in Children: A Multicenter Case Series of Clinical Features and Operative Results. Am J Sports Med 2023; 51:1171-1176. [PMID: 36876853 DOI: 10.1177/03635465231159671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND The discoid medial meniscus is a rare congenital anomaly of the knee. The literature is limited to small case series. PURPOSE/HYPOTHESIS Our purpose is to report the clinical manifestations and operative treatments of discoid medial menisci in children from multiple centers in North America. We hypothesized that symptoms and signs, arthroscopic findings, surgical treatments, and outcomes are similar to those for symptomatic discoid lateral menisci. STUDY DESIGN Case series; Level of evidence, 4. METHODS A retrospective review identified patients with a diagnosed discoid medial meniscus confirmed at surgery across 8 children's hospitals between January 2000 and June 2021. The literature on discoid lateral menisci was reviewed and summarized for comparison. RESULTS A total of 21 patients (9 female, 12 male) with 22 discoid medial menisci were identified. The mean ± SD age at the time of diagnosis was 12.8 ± 3.8 years. The most common symptoms and signs were locking and/or clunking, present in 12 of 22 knees (55%), similar to that reported in patients with discoid lateral menisci. Twelve discoid medial menisci were complete (55%); 8, incomplete (36%); and 2, indeterminate (9%). Tears were present in 13 knees, most commonly horizontal cleavage (54%). Five discoid medial menisci were unstable (23%): 3 for posterior tears and 2 for rim insufficiency. All 22 knees underwent arthroscopic saucerization, and of the 13 torn menisci, 7 (54%) were repaired. The median follow-up was 24 months (range, 2-82 months). Four knees underwent reoperation. All knees that required reoperation had undergone repair for a posteriorly located tear. There was a significant association between operative repair and need for reoperation (P = .0048). High rates of peripheral instability were also noted in case series of patients with discoid lateral menisci. CONCLUSION Patient presentations and treatments for those with discoid medial menisci were similar to those reported for patients with discoid lateral menisci. Knees with discoid medial menisci also demonstrated instability attributed to peripheral insufficiency and posterior tears. Tears were present in over half of knees with discoid medial menisci, and reoperation was more common in knees that underwent repair of tears than those without repair.
Collapse
|
10
|
Arthroscopic Treatment of Symptomatic Discoid Lateral Meniscus and Non discoid Meniscus in Adolescent Patients. Am J Sports Med 2022; 50:3805-3811. [PMID: 36342468 DOI: 10.1177/03635465221130455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Discoid lateral meniscus (DLM) is a rare condition. Patient-reported outcomes using validated instruments are underreported in the literature. DLM outcomes have not been directly compared with nondiscoid meniscus (non-DLM) in adolescent patients. PURPOSE/HYPOTHESIS This study sought to analyze the difference in patient characteristics, surgical treatment, and patient-reported outcomes for adolescent patients arthroscopically treated for symptomatic DLM and non-DLM pathology. We hypothesized that DLM and non-DLM patient-reported outcomes would be similar. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective review of patients aged <18 years with symptomatic DLM and non-DLM pathology was completed between 2015 and 2021 at a single academic institution. Chart reviews for patient characteristics and surgical operative indications and technique were completed. Patient-reported outcome scores were prospectively collected preoperatively and at 6 months, 1 year, and 2 years after surgery. RESULTS Patients in the DLM group (n = 48), when compared with the non-DLM group (n = 45), were younger (12.71 vs 15.78 years, respectively; P < .001) and had lower body mass index (24.53 vs 28.91, respectively; P < .02). Both groups were majority Hispanic and more commonly male (DLM 65% vs non-DLM 60%). All of the DLM patients had surgery on the lateral discoid meniscus (n = 48), whereas the non-DLM group had surgery on the lateral meniscus (n = 37), medial meniscus (n = 7), or both (n = 1). A majority of patients in both groups underwent meniscal repair (DLM 73% and non-DLM 62%), and there was no difference in surgical treatment between groups (P > .05). A statistically significant improvement was seen in International Knee Documentation Committee (IKDC) and Physical Activity Questionnaire (PAQ) scores from the preoperative assessment to 6 months, 1 year, and 2 years after surgery for both DLM and non-DLM groups (P < .05). No difference was found in scores between DLM and non-DLM groups, between sexes, or between age groups (<13 years or ≥13 years) (P > .05). CONCLUSION Although patients with DLM were younger and had lower body mass index, the IKDC and PAQ scores were not significantly different between the DLM and non-DLM groups. Both groups showed a significant improvement in scores relative to their preoperative scores. Sex and age did not affect IKDC or PAQ scores.
Collapse
|
11
|
T2 Relaxation Time Changes in the Distal Femoral Condylar Cartilage of Children and Young Adults with Discoid Meniscus. Cartilage 2022; 13:19476035221085142. [PMID: 35287484 PMCID: PMC9137297 DOI: 10.1177/19476035221085142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate compositional changes in the distal femoral condylar cartilage (FCC) of children and young adults with and without discoid meniscus by T2 relaxation time mapping. DESIGN We retrospectively reviewed knee magnetic resonance images including sagittal T2 maps of distal FCC performed in patients with or without discoid meniscus. Combined meniscal pathology such as degeneration or tears was also reviewed. Regions of interest were selected, and T2 relaxation time profiles were generated according to medial and lateral and FCC and according to weight-bearing and non-weight-bearing FCC. Nonparametric comparison tests using median values were performed. RESULTS Seventy-nine knees from 73 patients (2-20 years) including 45 knees with lateral discoid meniscus (discoid group) were studied. T2 values of FCC showed negative correlation with age in both the discoid and nondiscoid groups (P < 0.01), except for medial weight-bearing FCC. In the discoid group, T2 relaxation times of lateral weight-bearing FCC (median, 46.5 ms) were lower than those of lateral non-weight-bearing (median, 53.2 ms; P < 0.001) and medial weight-bearing (median, 50.5 ms; P = 0.012) FCC. Lateral weight-bearing FCC also showed lower T2 values than other areas in patients with meniscal pathology in the discoid group. However, T2 relaxation times did not differ between the discoid and nondiscoid groups in patients without meniscal pathology. CONCLUSIONS Children and young adults with discoid meniscus have lower T2 relaxation times in lateral weight-bearing FCC compared with non-weight-bearing or medial FCC, suggesting compositional changes have occurred in these patients.
Collapse
|
12
|
The Relationship Between Discoid Meniscus and Articular Cartilage Thickness: A Quantitative Observational Study With MRI. Orthop J Sports Med 2022; 9:23259671211062258. [PMID: 34988233 PMCID: PMC8721379 DOI: 10.1177/23259671211062258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 08/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Several cadaveric imaging studies have demonstrated that the articular cartilage thickness on the tibial plateau varies depending on coverage by native meniscal tissue. These differences are thought to partially contribute to the rates of cartilage degeneration and development of osteoarthritis after meniscectomy. Because there is greater tibial plateau coverage with meniscal tissue in the setting of a discoid meniscus, these findings may also have implications for the long-term health of the knee after saucerization of a torn discoid meniscus. Purpose: To evaluate the relationship between lateral compartment articular cartilage thickness and the presence or absence of a discoid meniscus. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Included in the study were 25 patients younger than 40 years of age who had undergone a 1.5-T or 3-T knee magnetic resonance imaging (MRI) between 2010 and 2016 at a single institution and had an intact, lateral discoid meniscus. Only patients with an otherwise asymptomatic lateral compartment were included. The authors then identified 35 age-matched controls with a nondiscoid, intact lateral meniscus who underwent knee MRI at the same institution and during the same period. The articular cartilage thicknesses in 6 zones of the lateral femoral condyle (LFC) and lateral tibial plateau (LTP) were measured for each patient by 2 musculoskeletal radiologists, and the mean thicknesses were compared between the study and control groups. Results: The average age at MRI was 22.63 years (range, 8.30-35.90 years) for the discoid group and 20.93 years (range, 8.43-34.99 years) for the nondiscoid group. The nondiscoid group had significantly greater mean articular cartilage thickness in all 6 zones of the LTP (P < .05 for all). When comparing the zones of the LFC, there was no significant difference in the mean thickness in any zone between the 2 groups. Conclusion: Patients with discoid menisci had thinner baseline articular cartilage thickness in the LTP compared with those patients without discoid menisci.
Collapse
|
13
|
Clinical efficacy of arthroscopy in the treatment of discoid meniscus injury and related risk factors for postoperative pain. ANNALS OF PALLIATIVE MEDICINE 2020; 9:4002-4009. [PMID: 33222461 DOI: 10.21037/apm-20-1899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/06/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Discoid meniscus is an abnormal meniscus of the knee joint. This study aimed to analyze the clinical efficacy of arthroscopy in the treatment of discoid meniscus injury, and determine the related risk factors for postoperative pain. METHODS A total of 80 patients with a discoid meniscus injury who were diagnosed and treated in our hospital from May 2017 to May 2018 were selected. According to the different surgical methods, they were divided into the study group (treated with meniscus plasty) or the control group (treated with subtotal meniscectomy). Knee joint motion and knee joint function were measured at 2, 6 and 12 weeks post-surgery. Knee joint function was measured using the Lysholm Knee Scoring Scale to determine clinical efficacy. Patients with an excellent and good rating were included in the painless group, and patients with an average and poor rating were included in the pain group. The risk factors for postoperative pain were analyzed using multivariate logistic regression. RESULTS Knee joint motion in the study group and the control group gradually increased and reached a peak 12 weeks after surgery (P<0.05), however, there was no significant difference between the 2 groups at each time point after surgery (P>0.05). The excellent and good rate, according to the Lysholm Knee Scoring Scale, was 84.62% in the study group and 84.38% in the control group. There was no significant difference between the 2 groups (P>0.05). There were differences between the pain group and the painless group in Watanabe classification, age, preoperative symptom time, cold compress, joint soft tissue injury, and postoperative weight-bearing time ≤1 week (P<0.05). CONCLUSIONS Arthroscopy demonstrated efficacy for the treatment of patients with a discoid meniscus injury. Age, duration of preoperative symptoms, articular cartilage injury, postoperative cold compress and postoperative weight-bearing time were independent risk factors that affected postoperative pain after arthroscopic surgery. For high-risk patients, effective prevention and control measures should be taken to improve postoperative pain and promote the recovery of knee joint function.
Collapse
|
14
|
Demographics and Epidemiology of Discoid Menisci of the Knee: Analysis of a Large Regional Insurance Database. Orthop J Sports Med 2020; 8:2325967120950669. [PMID: 32999890 PMCID: PMC7506788 DOI: 10.1177/2325967120950669] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 04/10/2020] [Indexed: 11/30/2022] Open
Abstract
Background: A discoid meniscus is a morphological variant of normal knee joint meniscus
shape and ultrastructure that can lead to traumatic tearing of this tissue
and early joint osteoarthritis. Purpose/Hypothesis: The purpose of this study was to determine the prevalence of discoid menisci
in a large, ethnically diverse regional cohort and to evaluate possible risk
factors. The hypothesis was that there would be no difference in the
epidemiological distribution of discoid menisci based on ethnicity or
sex. Study Design: Descriptive epidemiology study. Methods: The study population was from a regional, integrated health care system
cohort from Kaiser Permanente of Southern California that, as of 2016,
included more than 4.5 million patients. Patient demographics included age,
sex, and ethnicity within this cohort. Potential risk factors analyzed
included age, sex, ethnicity, and body mass index (BMI). Unique
characteristics of a discoid meniscus were analyzed, including a symptomatic
versus asymptomatic meniscus, location of meniscal tear and type of
meniscus, and frequency of meniscal surgical treatment. Results: A total of 223 patients with a confirmed discoid meniscus were identified,
yielding an overall prevalence rate of 4.88 per 100,000 patients. Those
identifying as Black had the lowest prevalence (2.68/100,000), while
Hispanic ethnicity had the highest (6.01/100,000). However, there was no
significant difference with regard to ethnicity (P = .283),
nor any significant difference between sexes. BMI did not significantly
influence the rate of discoid menisci (P = .504). A
majority (77.5%) of patients were symptomatic, while 22.5% of patients with
discoid menisci were asymptomatic and discovered incidentally. Symptomatic
discoid menisci were more likely to be operated on compared with
asymptomatic discoid menisci (71% vs 14%, respectively; P =
.001; odds ratio, 14.8 [95% CI, 5.8-37.2]). Horizontal and bucket-handle
tears were the more common tear types. Of the discoid menisci in this
cohort, 55.6% underwent surgery, with 95.2% undergoing reported
saucerization. Conclusion: In this very diverse population-based cohort of patients, there did not seem
to be a significant predilection of discoid menisci with regard to
ethnicity. Neither sex nor BMI significantly influenced the rate of discoid
menisci. More than three-quarters of those with a diagnosed discoid meniscus
were symptomatic. Of the tears that occurred with discoid menisci,
horizontal and bucket-handle tears made up the largest proportion.
Collapse
|
15
|
Arthroscopic All-Inside Repair of Tear of the Anterior Horn of Discoid Lateral Meniscus. Surg J (N Y) 2019; 5:e35-e37. [PMID: 31093532 PMCID: PMC6517238 DOI: 10.1055/s-0039-1688951] [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: 01/03/2019] [Accepted: 04/02/2019] [Indexed: 11/28/2022] Open
Abstract
The anterior horn of lateral meniscus tear is usually repaired using outside-in technique. Although easy to perform, it was associated with several complications which may alter the outcome of the surgery. Here, we present a case of an adolescent girl presented with incomplete discoid lateral meniscus accompanied by tear of anterior horn. The tear was repaired using all-inside technique without any implants. We described the surgical technique and discussed the rationale.
Collapse
|
16
|
Incidence and Treatment Trends of Symptomatic Discoid Lateral Menisci: An 18-Year Population-Based Study. Orthop J Sports Med 2018; 6:2325967118797886. [PMID: 30263899 PMCID: PMC6153536 DOI: 10.1177/2325967118797886] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: A symptomatic discoid lateral meniscus is an uncommon orthopaedic
abnormality, and the majority of information in the literature is limited to
small case series. Purpose/Hypothesis: The purpose of this study was to determine the incidence of symptomatic
discoid menisci in a geographically determined population and to describe
treatment trends over time. The hypothesis was that the incidence of
symptomatic discoid menisci would be highest among adolescent patients, and
thus, the rate of surgical treatment would be high compared with
nonoperative treatment. Study Design: Descriptive epidemiology study. Methods: The study population included 79 patients in Olmsted County, Minnesota,
identified through a geographic database, who were diagnosed with a
symptomatic discoid lateral meniscus between 1998 and 2015. The complete
medical records were reviewed to confirm the diagnosis and evaluate the
details of injury and treatment. Age- and sex-specific incidence rates were
calculated and adjusted to the 2010 United States population. Results: The overall annual incidence of symptomatic discoid lateral menisci was 3.2
(95% CI, 2.5-3.9) per 100,000 person-years; 12.6% of the patients in the
cohort had bilateral symptomatic discoid lateral menisci. The overall annual
incidence was similar between male (3.5 per 100,000 person-years) and female
patients (2.8 per 100,000 person-years). The highest incidence of
symptomatic discoid lateral menisci was noted in adolescent male patients
aged 15-18 years (18.8 per 100,000 person-years). A majority (72.2%) of
patients presented with a symptomatic tear of the discoid meniscus. The
remaining patients presented with mechanical symptoms, including
catching/locking or effusion, with no demonstrable meniscus tear on imaging
or diagnostic arthroscopic surgery. Additionally, 20.0% of patients were
observed to have peripheral instability of the meniscus at the time of
diagnostic arthroscopic surgery. The mean age of those with peripheral
instability was significantly younger than of those who did not have
peripheral instability. Sixty patients (75.9%) received surgical treatment
during the study period, including 49 (81.7%) patients who underwent partial
lateral meniscectomy and 11 (18.3%) patients who underwent lateral meniscus
repair in addition to saucerization. Conclusion: With an overall annual incidence of 3.2 per 100,000 person-years, a
symptomatic discoid meniscus is an uncommonly encountered orthopaedic
abnormality. However, the incidence of symptomatic discoid lateral menisci
is highest in adolescent male patients. Because of the high rate of meniscus
tears in patients presenting with symptoms, the majority are treated
surgically.
Collapse
|
17
|
Transient Common Peroneal and Tibial Nerve Palsy Following Knee Arthroscopy for the Treatment of Discoid Lateral Meniscus. JOINTS 2017; 5:118-120. [PMID: 29114641 PMCID: PMC5672866 DOI: 10.1055/s-0037-1603674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The number of knee arthroscopies has increased rapidly since the 1980s and are among the most common orthopedic procedures today. It is generally considered a minimally invasive surgery with relatively low morbidity, but it is not without risk of complications. We report the case of a 14-year-old boy who developed a lesion of common peroneal nerve and tibial nerve after knee arthroscopy for a torn discoid lateral meniscus, which was confirmed by electromyogram study.
Collapse
|
18
|
Evolution of Osteochondritis Dissecans of the Lateral Femoral Condyle Combined with Discoid Meniscus. JOINTS 2017; 5:114-117. [PMID: 29114640 PMCID: PMC5672867 DOI: 10.1055/s-0037-1603673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The discoid meniscus is a rare anomaly of the knee that affects mostly the lateral meniscus and is often asymptomatic. The osteochondritis dissecans is a disorder of the subchondral bone and articular cartilage and occurs frequently associated with the discoid lateral meniscus. In the present case, we showed the evolution of this association related to surgical treatment. A patient with lateral knee pain and a magnetic resonance depicting a torn discoid lateral meniscus and osteochondritis dissecans of the lateral femoral condyle was treated with partial meniscectomy and meniscal sutures. After 1 year, the symptoms reappeared, and a new meniscal repair was performed to treat a bucket-handle tear, while cartilage was apparently intact. After 4 years, there was a new recurrence of symptoms, and the knee developed a valgus deformity. Cartilage was treated with microfractures, and a subsequent distal femoral osteotomy associated with lateral meniscal scaffold was performed. The patient was followed up clinically, with radiographs and magnetic resonance for 5 years with an improvement of the results up to 2 years and no signs of deterioration of results over time.
Collapse
|
19
|
Abstract
PURPOSE Achondroplasia is the most common form of skeletal dysplasia, affecting more than 250 000 individuals worldwide. In these patients, the developing knee undergoes multiple anatomical changes. The purpose of this study was to characterise the intra-articular knee anatomy in children with achondroplasia who underwent knee arthroscopy. METHODS Records of achondroplasia patients who underwent knee arthroscopy between 2009 and 2014 were reviewed. Demographic data, operative reports, follow-up notes, MRI and arthroscopy images were reviewed. Bony, cartilaginous and ligamentous changes were noted. The trochlea sulcus angle was measured from intra-operative arthroscopic images. RESULTS A total of 12 knee arthroscopies in nine patients were performed. The mean age at surgery was 16.9 years (12 to 22). In all patients, the indication for surgery was knee pain and/or mechanical symptoms that were refractory to non-operative treatment. Three anatomical variations involving the distal femur were found in all knees: a deep femoral trochlea; a high A-shaped intercondylar notch; and a vertically oriented anterior cruciate ligament. The average trochlea sulcus angle measured 123°. Pathology included: synovial plica (one knee); chondral lesions (three knees); discoid lateral meniscus (11 knees); and meniscal tears (six knees). All patients were pain-free and returned to normal activity at final follow-up. CONCLUSION Children with achondroplasia have characteristic distal femur anatomy noted during knee arthroscopy. These variations should be considered normal during knee arthroscopy in these patients. Arthroscopic findings confirmed previous MRI findings within this specific population with the addition of a deep trochlear groove which was not previously reported.
Collapse
|
20
|
Abstract
BACKGROUND The collagen ultrastructure of the discoid lateral meniscus (DLM) has not been precisely defined. PURPOSE To investigate the ultrastructure of the DLM, focusing on its collagen fibers, and to compare the collagen net architecture between intact and torn DLMs using the Collagen Meniscal Architecture (CMA) scoring system. STUDY DESIGN Descriptive laboratory study. METHODS Thirty specimens were taken from 30 patients with a diagnosis of a complete DLM using a 1-piece technique. The collagen ultrastructure of the DLMs was assessed with transmission electron microscopy. To evaluate the meniscal ultrastructure, the degree of collagen disruption, intrafibrillar edema, loss of banding, degree of collagen packing, and fibril size variability were assessed and graded from 1 (normal) to 3 (severe disarray) according to the CMA scoring system. The DLM specimens were divided into 3 groups according to the intrasubstance tear: the intact group (group I) had no tear; the simple tear group (group S) had a radial, longitudinal, or horizontal tear; and the complicated tear group (group C) had a complicated horizontal tear. Intact normal meniscus specimens (group N) were used as the control group. RESULTS There were 10 specimens in group I, 8 in group S, 12 in group C, and 13 in group N. In group I, there were 5 grade 1 and 5 grade 2 menisci; group S had 2 grade 1, 3 grade 2, and 3 grade 3 menisci; group C had 1 grade 1, 4 grade 2, and 7 grade 3 menisci; and group N had 4 grade 1, 7 grade 2, and 2 grade 3 menisci. A significant difference in the CMA score was observed between the 4 groups ( P = .009). The median CMA score was significantly lower in group I (2; range, 1-4) than in group S (4; range, 2-7) ( P = .041) and group C (4.25; range, 1.5-7) ( P = .018). No significant difference was found between groups S, C, and N. CONCLUSION Variability existed in the collagen ultrastructure of the DLM, and some DLMs showed a nearly normal ultrastructural pattern. The degree of density and disorganization of the collagen architecture in the DLM was related to the tear. CLINICAL RELEVANCE The study results might provide a histological background for partial meniscectomy in the treatment of a symptomatic DLM.
Collapse
|
21
|
Posterolateral rotatory instability of the knee after arthroscopic subtotal lateral meniscectomy: a case report. JOINTS 2015; 2:93-6. [PMID: 25606550 DOI: 10.11138/jts/2014.2.2.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 33-year-old Caucasian woman came to our attention complaining of lateral knee pain on the left side, severe external instability associated with varus malalignment, and difficulties in weight-bearing activities. The symptoms had appeared following two lateral meniscectomies on her discoid meniscus, performed elsewhere. The patient was initially submitted to an allograft meniscus transplantation exploiting the unloaded condition of lateral compartment and obtained pain relief. The posterolateral corner was reconstructed in combination with a valgus osteotomy to address the posterolateral rotatory instability. The follow-up assessment at two years after the last surgery showed no symptoms, maintenance of limb alignment and no evidence of joint degeneration.
Collapse
|