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Discoid lateral meniscus instability in children: part I. A new grading system of instability to clarify natural history

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

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Abstract

Objective

In young patients, the discoid lateral meniscus (DLM) usually becomes symptomatic at the time of peripheral rim instability of a complete discoid form. However, little is known about the natural history of meniscal instability. The aim was to detect hidden forms of presentation of instability using the history and clinical mechanical symptoms of instability.

Methods

Retrospective study of 114 paediatric knees treated for DLM. A new clinical grading system for instability (stable, locked, snapping, blocked and unblocked knees) was defined and studied in combination with MRI and arthroscopic findings.

Results

One hundred seven DLMs (94%) showed instability due to edge detachment. Fifteen (13%) knees were stable (grade 0), 2 (2%) were grade 1, 57 (50%) were grade 2, 35 (31%) were grade 3 and 5 (4%) were grade 4. The cause of grade 3 was an extension deficit (26/35) or flexion deficit (9/35). Grade 1 or 2 correlated with limited detachment, unlike grade 3 or 4. The grade of instability never decreased, but rather increased in many knees during the natural history of DLM.

Conclusion

A new presentation of DLM is presented: episodic locking phenomenon and blocked knee with flexion deficit. Clinicians should be wary of pseudo-improvement with the recovery of mobility after a period of the blocked knee, which may be due to a progression towards the ultimate degree of instability. Clinical grading of instability has clarified the natural history of DLM-associated tearing.

Level of evidence

III.

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Data availability

Data are availlable.

Change history

  • 01 September 2023

    In Abstract under Conclusion, the word locked knee changed to blocked knee.

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Acknowledgements

Camille Vandergugten, Véréna Landel from the Department of Publication of the Hospices Civils de Lyon, for their help in manuscript preparation, Julien Berthiller and Dr Parot for help in statistical analysis and thanks to Pr Romain Seil and Dr Radj Pem for English corrections.

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No funding.

Author information

Authors and Affiliations

  1. Pediatric Orthopaedic Surgery Unit, Cliniques Universitaires UCL Saint-Luc Bruxelles, Grand Hopital de Charleroi, Charleroi, Belgium

    Vandergugten Simon

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

    Bauwens Paul Henri, Cance Nicolas, Raux Sebastien & Chotel Franck

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

    Fiquet Charles

  4. Direction de la Santé, Hospices Civils de Lyon, 3 quai des Célestins, 69002, Lyon, France

    Boyer Hélène

  5. Hospices civils de Lyon, Claude Bernard University Lyon I, Lyon, France

    Chotel Franck

Authors
  1. Vandergugten Simon
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  4. Boyer Hélène
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Contributions

Contribution to data analysis and writing manuscripts for VS and BPH. Analysis and interpretation of data for others authors. BH for her significant participation in the editing of the manuscript. Contributions to conception and design and analysis and interpretation of data for FC.

Corresponding author

Correspondence to Chotel Franck.

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No conflict of interest for any author and co-authors.

Ethical approval

The study protocol was approved by Lyon university hospital for Mothers and Children, and Claude Bernard University Lyon I research ethics board (N°20_069).

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Retrospective study.

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Simon, V., Paul Henri, B., Charles, F. et al. Discoid lateral meniscus instability in children: part I. A new grading system of instability to clarify natural history. Knee Surg Sports Traumatol Arthrosc 31, 4809–4815 (2023). https://doi.org/10.1007/s00167-023-07521-w

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