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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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References

  1. Adachi N, Ochi M, Uchio Y, Kuriwaka M, Shinomiya R (2004) Torn discoid lateral meniscus treated using partial central meniscectomy and suture of the peripheral tear. Arthroscopy 20(5):536–542

    Article  PubMed  Google Scholar 

  2. Ahn JH, Kim KI, Wang JH, Jeon JW, Cho YC, Lee SH (2015) Long-term results of arthroscopic reshaping for symptomatic discoid lateral meniscus in children. Arthroscopy 31(5):867–873

    Article  PubMed  Google Scholar 

  3. Ahn JH, Lee YS, Ha HC, Shim JS, Lim KS (2009) A novel magnetic resonance imaging classification of discoid lateral meniscus based on peripheral attachment. Am J Sports Med 37(8):1564–1569

    Article  PubMed  Google Scholar 

  4. Ahn JH, Lee SH, Kim KI, Nam J (2018) Arthroscopic meniscus repair for recurrent subluxation of the lateral meniscus. Knee Surg Sports Traumatol Arthrosc 26(3):787–792

    Article  PubMed  Google Scholar 

  5. Ahn JH, Lee SH, Yoo JC, Lee YS, Ha HC (2008) Arthroscopic partial meniscectomy with repair of the peripheral tear for symptomatic discoid lateral meniscus in children: results of minimum 2 years of follow-up. Arthroscopy 24(8):888–898

    Article  PubMed  Google Scholar 

  6. Asik M, Sen C, Taser OF, Alturfan AK, Sozen YV (2003) Discoid lateral meniscus: diagnosis and results of arthroscopic treatment. Knee Surg Sports Traumatol Arthrosc 11(2):99–104

    Article  PubMed  Google Scholar 

  7. Beck JJ, Schlechter J, Schmale G, Haus B, Lee J (2022) Comprehensive arthroscopic characterization of discoid meniscus tears and instability using the PRiSM discoid meniscus classification. Arthrosc Tech 11(7):e1347–e1352

    Article  PubMed  PubMed Central  Google Scholar 

  8. Bin SI, Jeong SI, Kim JM, Shon HC (2002) Arthroscopic partial meniscectomy for horizontal tear of discoid lateral meniscus. Knee Surg Sports Traumatol Arthrosc 10(1):20–24

    Article  PubMed  Google Scholar 

  9. Carter CW, Hoellwarth J, Weiss JM (2012) Clinical outcomes as a function of meniscal stability in the discoid meniscus: a preliminary report. J Pediatr Orthop 32(1):9–14

    Article  PubMed  Google Scholar 

  10. Collins NJ, Misra D, Felson DT, Crossley KM, Roos EM (2011) Measures of knee function: international knee documentation committee (IKDC) subjective knee evaluation form, knee injury and osteoarthritis outcome score (KOOS), knee injury and osteoarthritis outcome score physical function short form (KOOS-PS), knee outcome survey activities of daily living scale (KOS-ADL), Lysholm knee scoring scale, Oxford knee score (OKS), western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), activity rating scale (ARS), and Tegner activity score (TAS). Arthritis Care Res 63(Suppl 11):S208-228

    Google Scholar 

  11. Dai Z, Chen J, Chen S, Chen Z, Fan W, Liao Y, Jiang J (2011) Meniscal plasty and suture repair for torn discoid lateral meniscus involving popliteal hiatus. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 25(1):13–16

    PubMed  Google Scholar 

  12. Good CR, Green DW, Griffith MH, Valen AW, Widmann RF, Rodeo SA (2007) Arthroscopic treatment of symptomatic discoid meniscus in children: classification, technique, and results. Arthroscopy 23(2):157–163

    Article  PubMed  Google Scholar 

  13. Hagino T, Ochiai S, Senga S, Yamashita T, Wako M, Ando T, Haro H (2017) Arthroscopic treatment of symptomatic discoid meniscus in children. Arch Orthop Trauma Surg 137(1):89–94

    Article  PubMed  Google Scholar 

  14. Hashimoto Y, Yamasaki S, Guttmann D, Reid JB 3rd, Marvil S, Kinoshita T, Nakamura H (2022) Surgical management of discoid lateral meniscus with anterior peripheral instability: retaining an adequate residual meniscus volume. Arthrosc Tech 11(7):e1141–e1147

    Article  PubMed  PubMed Central  Google Scholar 

  15. Haskel JD, Uppstrom TJ, Dare DM, Rodeo SA, Green DW (2018) Decline in clinical scores at long-term follow-up of arthroscopically treated discoid lateral meniscus in children. Knee Surg Sports Traumatol Arthrosc 26(10):2906–2911

    Article  PubMed  Google Scholar 

  16. Kang MS, Kim JM, Park SS, Bin SI (2019) Prediction of the peripheral rim instability of the discoid lateral meniscus in children by using preoperative clinicoradiological factors. J Pediatr Orthop 39(10):e761–e768

    Article  PubMed  Google Scholar 

  17. Kinugasa K, Hamada M, Yonetani Y, Matsuo T, Mae T, Nakata K, Horibe S (2019) Discoid lateral meniscal repair without saucerization for adolescents with peripheral longitudinal tear. Knee 26(3):803–808

    Article  PubMed  Google Scholar 

  18. Kim SH, Ahn J, Kim TW, Kim KI, Lee SH (2019) Midbody of the medial meniscus as a reference of preservation in partial meniscectomy for complete discoid lateral meniscus. Knee Surg Sports Traumatol Arthrosc 27(8):2558–2567

    Article  PubMed  Google Scholar 

  19. Klingele KE, Kocher MS, Hresko MT, Gerbino P, Micheli LJ (2004) Discoid lateral meniscus: prevalence of peripheral rim instability. J Pediatr Orthop 24(1):79–82

    Article  PubMed  Google Scholar 

  20. Kocher MS, Logan CA, Kramer DE (2017) Discoid Lateral meniscus in children: diagnosis, management, and outcomes. J Am Acad Orthop Surg 25(11):736–743

    Article  PubMed  Google Scholar 

  21. Lee DH, D’Lima DD, Lee SH (2019) Clinical and radiographic results of partial versus total meniscectomy in patients with symptomatic discoid lateral meniscus: a systematic review and meta-analysis. Orthop Traumatol Surg Res 105(4):669–675

    Article  PubMed  Google Scholar 

  22. Lee RJ, Nepple JJ, Schmale GA, Niu EL, Beck JJ, Milewski MD, Finlayson CJ, Joughin VE, Stinson ZS, Pace JL, PRiSM Meniscus Research Interest Group, Albright J, Carsen S, Chambers H, Nault ML, Schlechter JA, Stavinoha TJ, Tompkins M, Wilson PL, Heyworth BE (2022) Reliability of a new arthroscopic discoid lateral meniscus classification system: a multicenter video analysis. Am J Sports Med 50(5):1245–1253

    Article  PubMed  Google Scholar 

  23. Lins LAB, Feroe AG, Yang B, Williams KA, Kocher SD, Sankarankutty S, Micheli LJ, Kocher MS (2021) Long-term minimum 15-year follow-up after lateral discoid meniscus rim preservation surgery in children and adolescents. J Pediatr Orthop 41(9):e810–e815

    Article  PubMed  Google Scholar 

  24. Liu W, Fu C, Kang K, Huang T, Jiang S, Gu J, Gao S (2022) Evaluation of tibial eminence morphology using magnetic resonance imaging (MRI) in juvenile patients with complete discoid lateral meniscus. BMC Musculoskelet Disord 23(1):1022

    Article  PubMed  PubMed Central  Google Scholar 

  25. Logan CA, Tepolt FA, Kocher SD, Feroe AG, Micheli LJ, Kocher MS (2021) Symptomatic discoid meniscus in children and adolescents: a review of 470 cases. J Pediatr Orthop 41(8):496–501

    Article  PubMed  Google Scholar 

  26. Ng YH, Tan SHS, Lim AKS, Hui JH (2021) Meniscoplasty leads to good mid-term to long-term outcomes for children and adolescents with discoid lateral meniscus. Knee Surg Sports Traumatol Arthrosc 29(2):352–357

    Article  PubMed  Google Scholar 

  27. Ohnishi Y, Nakashima H, Suzuki H, Nakamura E, Sakai A, Uchida S (2018) Arthroscopic treatment for symptomatic lateral discoid meniscus: the effects of different ages, groups and procedures on surgical outcomes. Knee 25(6):1083–1090

    Article  PubMed  Google Scholar 

  28. Papadopoulos A, Kirkos JM, Kapetanos GA (2009) Histomorphologic study of discoid meniscus. Arthroscopy 25(3):262–268

    Article  PubMed  Google Scholar 

  29. Perkins CA, Busch MT, Christino MA, Willimon SC (2021) Saucerization and repair of discoid lateral menisci with peripheral rim instability: intermediate-term outcomes in children and adolescents. J Pediatr Orthop 41(1):23–27

    Article  PubMed  Google Scholar 

  30. Smuin DM, Swenson RD, Dhawan A (2017) Saucerization versus complete resection of a symptomatic discoid lateral meniscus at short- and long-term follow-up: a systematic review. Arthroscopy 33(9):1733–1742

    Article  PubMed  Google Scholar 

  31. Vandergugten S, Bauwens PH, Fiquet C, Boyer H, Raux S, Cance N, Chotel F (2023) Discoid lateral meniscus instability in children: part I. A new grading system of instability to clarify natural history. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-023-07521-w

    Book  Google Scholar 

  32. Wasser L, Knörr J, Accadbled F, Abid A, Sales De Gauzy J (2011) Arthroscopic treatment of discoid meniscus in children: clinical and MRI results. Orthop Traumatol Surg Res 97(3):297–303

    Article  CAS  PubMed  Google Scholar 

  33. Yamaguchi N, Chosa E, Tajima T, Morita Y, Yokoe T (2022) Symptomatic discoid lateral meniscus shows a relationship between types and tear patterns, and between causes of clinical symptom onset and the age distribution. Knee Surg Sports Traumatol Arthrosc 30(4):1436–1442

    Article  PubMed  Google Scholar 

  34. Yamasaki S, Hashimoto Y, Takigami J, Terai S, Takahashi S, Nakamura H (2017) Risk factors associated with knee joint degeneration after arthroscopic reshaping for juvenile discoid lateral meniscus. Am J Sports Med 45(3):570–577

    Article  PubMed  Google Scholar 

  35. Yilgor C, Atay OA, Ergen B, Doral MN (2014) Comparison of magnetic resonance imaging findings with arthroscopic findings in discoid meniscus. Knee Surg Sports Traumatol Arthrosc 22(2):268–273

    Article  PubMed  Google Scholar 

  36. Yoo WJ, Choi IH, Chung CY, Lee MC, Cho TJ, Park MS, Lee DY (2008) Discoid lateral meniscus in children: limited knee extension and meniscal instability in the posterior segment. J Pediatr Orthop 28(5):544–548

    Article  PubMed  Google Scholar 

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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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  4. Sébastien Raux
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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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Ethical approval

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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