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Discoid lateral meniscus instability in children: part II.: Repair first to minimise the saucerisation

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Despite an improved understanding of discoid lateral meniscus (DLM), the treatment of symptomatic discoid lateral meniscus remains controversial.

Methods

The aim of this retrospective, single-centred, consecutive-case study was to evaluate the clinical outcome of 60 DLM treated arthroscopically by the “meniscoplasty or saucerisation–suture” technique in children and adolescents [median (range) age 11 (4–17) years], and to investigate surgical failures. The instability was assessed before any saucerisation. The hypotheses were that: (i) the management of instability with suture first was effective and that (ii) a combined classification with clinical and MRI data had a prognostic value.

Results

In 57 knees (95%), the DLM was unstable, and a suture fixation was performed. After a median follow-up of 41.5 months, the median (range) IKDC score was improved from 55 (10–70) preoperatively to 90 (37.5–100) postoperatively. The median (range) Lysholm score at last follow-up was 93.5 (45–100). The procedure was effective in 49 knees (81.6%) after a single procedure. Eleven patients had a failure with a new meniscal tear after a median (range) delay of 42 months (24–60) after the initial procedure. The patterns of discoid lateral meniscus instability were not found to have a prognostic value for surgical failure since they mainly occurred after sport-related injuries. All the patients with initial repair failures but one achieved a good clinical outcome after revision repair without any further meniscectomy.

Conclusion

In contrast to adult knees, symptomatic discoid lateral meniscus is rarely stable in children (5%). Meniscal repair is effective to preserve the meniscus tissue, but revision repair became necessary in 18% of the cases and was finally successful.

Level of evidence Level III.

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Acknowledgements

Thanks to Roger Parot for help in statistics analysis and to Hélène Boyer from the department of publication of the Hospices Civils de Lyon for help in manuscript preparation. Thanks to Dr Raj Pem for help in English translation.

Funding

There is no funding.

Author information

Authors and Affiliations

  1. Department of Pediatric Orthopaedic Surgery, Lyon University Hospital for Mother and Children, 59 Boulevard Pinel, 69677, Bron, France

    Paul Henri Bauwens, Sébastien Raux & Nicolas Cance

  2. Pediatric Orthopaedic Surgery Unit, Cliniques Universitaires UCL Saint-Luc Bruxelles, and in Grand Hopital de Charleroi, Lyon, France

    Simon Vandergugten

  3. Clinique de l’infirmerie Protestante of Lyon, 1-3 Chemin du Penthod, 69300, Caluire et Cuire, France

    Charles Fiquet

  4. Department of Pediatric Orthopaedic Surgery, Lyon University Hospital for Mother and Children and Claude Bernard University Lyon I., Hospices Civils de Lyon, 59 Boulevard Pinel, 69677, Bron, France

    Franck Chotel

Authors
  1. Paul Henri Bauwens
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  2. Simon Vandergugten
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  3. Charles Fiquet
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  4. Sébastien Raux
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  5. Nicolas Cance
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  6. Franck Chotel
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Contributions

BPH and VS contributed in the data analyses and writing of the manuscript. The other authors contributed to the analysis and interpretation of data. CF contributed to the conception and design, and analysis and interpretation of data.

Corresponding author

Correspondence to Franck Chotel.

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The study protocol was approved by Lyon university hospital for Mother and children and Claude Bernard University Lyon I research ethics board (N°20_070).

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Retrospective study.

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Bauwens, P.H., Vandergugten, S., Fiquet, C. et al. Discoid lateral meniscus instability in children: part II.: Repair first to minimise the saucerisation. Knee Surg Sports Traumatol Arthrosc 31, 4816–4823 (2023). https://doi.org/10.1007/s00167-023-07538-1

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