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

doi:10.1016/j.arthro.2014.12.012

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 31, Issue 5, May 2015, Pages 867-873

Presented at the 2013 Arthroscopy Association of North America meeting.

https://doi.org/10.1016/j.arthro.2014.12.012 Get rights and content

Purpose

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.

Methods

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.

Results

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.

Conclusions

Arthroscopic reshaping for symptomatic discoid lateral meniscus in children led to satisfactory clinical outcomes after a mean of 10.1 years. 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 of Evidence

Level IV, therapeutic case series.

Section snippets

Patient Demographic Data

From June 1997 to May 2004, the senior author (J.H.A.) performed arthroscopic surgery in 60 children (72 knees) with symptomatic DLM. This study included 38 of these patients (48 knees) who were able to return for the final evaluation after a minimum follow-up of 8 years (mean, 10.1 years; range, 8 to 14 years). Ten patients received bilateral operations for DLM. The mean age at operation was 9.9 years (range, 4 to 15 years); 19 knees were in children younger than 10 years, and 29 knees were in

Results

According to the scale of Ikeuchi,² the result was excellent in 31 knees, good in 14 knees, and fair in 3 knees at final follow-up. Therefore 45 knees (94%) showed excellent or good clinical results. At the last follow-up, the median Tegner activity level was 7 (range, 4 to 10). The mean Lysholm knee score improved from 74.9 ± 10.6 preoperatively to 97.6 ± 4.0 at final follow-up (P < .0001), and the mean Hospital for Special Surgery score improved from 80.8 ± 8.9 preoperatively to 97.8 ± 3.6 at

Discussion

The most important finding of our study is that meniscal reshaping by partial meniscectomy with or without repair was associated with less progression of degenerative changes than was subtotal meniscectomy regarding long-term results. We suggest that DLM should be treated with arthroscopic partial meniscectomy with or without meniscal repair according to the presence or absence of peripheral tears. In our series 40 knees (83%) underwent meniscal reshaping through partial meniscectomy with or

Conclusions

Arthroscopic reshaping for symptomatic DLM in children led to satisfactory clinical outcomes after a mean of 10.1 years. 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.

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To evaluate the experiences and outcomes of arthroscopic partial meniscectomy in symptomatic non-Wrisberg discoid lateral meniscus in children younger than 12 years old at a single center.
We retrospectively reviewed the medical records of all pediatric patients who were treated for non-Wrisberg discoid meniscus at our institute between 2013 and 2021. Patients were separated into 2 groups: Patients who underwent partial resection with saucerization (group A) or patients who underwent saucerization, tear repair, and fixation (group B). Clinical outcomes were compared between the 2 groups.
A total of 20 patients (22 knees) were treated for non-Wrisberg discoid meniscus and included in this study. Nine patients underwent partial resection with saucerization (group A) whereas 11 patients underwent saucerization, tear repair, and fixation (group B). The average follow-up was 3 years (range 2-10 years). The results showed that 17 of the 20 patients had excellent outcomes whereas the other 3 had good outcomes after a minimum follow-up of 2 years. The average Knee Injury and Osteoarthritis Outcome Score for Children score was 93.
Arthroscopic saucerization of symptomatic non-Wrisberg discoid lateral meniscus, with additional repair as indicated results in excellent or good outcomes in children younger than 12 years of age.
Level III, case–control study.
Arthroscopic Suture-Saucerization of Discoid Meniscus Allows Volume Conservation but Does Not Fully Restore Coverage
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To quantify the effect of meniscoplasty suture-saucerization on volume and surface coverage of lateral discoid menisci.
This retrospective study included all consecutive 10 patients treated between 2014 and 2019 who had magnetic resonance imaging before and after surgery and 15 controls. The MITK 3M3 semiautomatic software was used to segment the meniscus and cartilage before and after surgery to measure the percentage of meniscus coverage on the tibial cartilage. Results are compared to control patients without knee pathology matched on sex and age with Student t test.
Discoid meniscus surface and volume before surgery were respectively 597 mm² (range, 550-887 mm²) and 2,822 mm³ (1,571-3,407 mm³), representing 74.5% (56%-89%) of the tibial cartilage surface. After surgery, it decreased to 422 mm² (229-569 mm²) and 1,235 mm³ (680-1,738 mm³), leading to 45.7% (22.5%-68.6%) coverage. In the control group, median surface was 457 mm² (314-641 mm²), volume was 1,321 mm³ (641-2,240 mm³), and tibial coverage was 55% (41%-77%). Altogether, meniscus volume after surgery was similar to normal, while coverage was significantly lower than controls (P = .04).
Meniscoplasty suture-saucerization procedure may allow meniscus sparing and restauration of a similar to normal meniscus volume. Meniscus surface and coverage are diminished compared to controls. Both surface and volume normalization is usually not achievable without decreasing the thickness of the rather thick discoid meniscus.
Both surface and volume normalization is usually not achievable without decreasing the thickness of thick discoid menisci.
Effect of the volume of resected discoid lateral meniscus on the contact stress of the tibiofemoral joint: A finite element analysis
2023, Knee
Partial meniscectomy is commonly performed for symptomatic patients with discoid lateral meniscus (DLM) if conservative treatment fails. However, the development of knee osteoarthritis and osteochondral lesion are detrimental postoperative complications. This study aimed to evaluate the effect of the volume of resected DLM on the contact stress of the tibiofemoral joint using a finite element analysis.
Subject-specific finite-element models of the knee joint of a patient with DLM were developed from computed tomographic and magnetic resonance images. To evaluate the effect of partial meniscectomy on the contact stress in the lateral tibiofemoral joint, six knee models were created in the study (the native DLM, and five partially meniscectomized DLMs (according to the preserved width of the meniscus: 12 mm, 10 mm, 8 mm, 6 mm, and 4 mm)).
As the volume of resected DLM increased, higher contact stress was applied to the lateral tibiofemoral joint. Greater contact stress was applied to the preserved lateral meniscus than to the native DLM.
From a biomechanical viewpoint, the native DLM was the most protective against lateral tibiofemoral contact stress in comparison to partially meniscectomized DLMs.
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Finite element study of a partial meniscectomy of a complete discoid lateral meniscus in adults
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Incidence of osteoarthritis and genu valgus is higher after partial meniscectomy of the discoid lateral meniscus. We aimed to provide a biomechanical reference for slowing the development of osteoarthritis and genu valgus after complete discoid lateral meniscus (CDLM) surgery.
Computed tomography and magnetic resonance images of the knee were used to establish a finite element model of the knee. The discoid lateral meniscus model was cut at 2-mm intervals to obtain 10 lateral meniscus models of different widths (2–20 mm). The instantaneous stress peak and knee valgus angle were obtained by finite element analysis under the same coaxial load.
When the residual width of the lateral meniscus was greater than 12 mm, the peak stress of the knee joint and angle of genu valgus did not significantly change from preoperative levels. The contact stress peak increased slightly as the width decreased from 12 to 8 mm. When the width was reduced from 8 to 0 mm, the contact stress peak increased significantly.
For partial meniscectomy in CDLM patients, meniscus width of 8–10 mm provides a better biomechanical environment. This may reduce risk of early knee degeneration and valgus from excessive meniscectomy in conventional surgery.
Partial resection of lateral discoid meniscus changes lower limb axial alignment – A retrospective cohort study
2022, Knee
This study aimed to explore the changes in lower limb axial alignment and knee joint function after arthroscopic partial resection of the discoid lateral meniscus.
Preoperative and postoperative full-length weight-bearing radiographs of the lower limb were obtained from a total of 161 patients with lateral menisci tears from September 2018 to September 2020 who underwent partial meniscal resection. The patients were divided into discoid meniscus group (DMG) and ordinary meniscus group (OMG). The measured mechanical axis deviation (MAD), proximal tibia angle (PTA), and distal femoral angle (DFA) in the axial alignment of the lower limb were determined before and after surgery. Knee joint function on the affected side was determined using the International Knee Documentation Committee (IKDC) subjective scale and the Lysholm knee scoring scale before surgery and at one, six, 12, and 24 months after surgery.
For MAD and DFA, there were statistically significant differences between the preoperative and postoperative findings within each group (P < 0.01); the MAD and DFA were smaller after surgery. The difference in preoperative and postoperative PTA of the DMG was statistically significant (P < 0.01), meaning that the PTA becomes larger after surgery. The differences in preoperative and postoperative PTA of the OMG, preoperative PTA between the two groups, and postoperative PTA between the two groups were not statistically significant (P > 0.05). Intragroup comparisons of the IKDC subjective scale and the Lysholm knee scoring scale before and after surgery revealed significant differences (P < 0.05).
Arthroscopic partial resection of the discoid lateral meniscus is a safe and effective surgical method that can significantly improve knee joint function. Although the axial arrangement of the lower limbs will be slightly changed in the early stage, it will still be within the normal range after surgery in patients with normal lower limb axial alignment. For patients with varus or valgus before surgery, this procedure should be applied with caution.

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: The authors report the following potential conflict of interest or source of funding: This work supported by a grant from Kyung Hee University in 2004 (KHU-20140712) and Sports Scientification of Convergent R&D Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (NRF-2014M3C1B1033320).

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

Purpose

Methods

Results

Conclusions

Level of Evidence

Section snippets

Patient Demographic Data

Results

Discussion

Conclusions

Arthroscopy

Arthroscopy

Acta Radiol

Injury

Arthroscopy

Arthroscopy

Knee Surg Relat Res

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopic treatment of the discoid lateral meniscus. Technique and long-term results

Clin Orthop Relat Res

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

J Pediatr Orthop B

Discoid lateral meniscus and the frequency of meniscal tears

Skeletal Radiol

Discoid lateral meniscus in children: Clinical manifestations and morphology

J Pediatr Orthop

Arthroscopic partial meniscectomy for horizontal tear of discoid lateral meniscus

Knee Surg Sports Traumatol Arthrosc

Discoid lateral meniscus

Am J Knee Surg

Discoid lateral menisci in Japanese cadaver knees

Mod Rheumatol

Symptomatic torn discoid lateral meniscus in adults

Knee Surg Sports Traumatol Arthrosc

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