Skip to main content

Advertisement

SpringerLink
Log in

Older age and the presence of intrameniscal signs are risk factors for nonsurgical treatment failure of symptomatic intact discoid lateral meniscus

  • KNEE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The treatment for symptomatic intact discoid lateral meniscus (DLM) is controversial and the long-term clinical outcome remains unknown. The purpose of this study was to analyze the overall failure rate of nonsurgical treatment for symptomatic intact DLM and identify the risk factors for nonoperative management failure.

Methods

Consecutive patients who underwent nonsurgical treatment for symptomatic intact DLM at our hospital from 2014 to 2017 were retrospectively reviewed. Patients were divided into Group A (failure group) and Group B (nonfailure group) based on overall failure criteria: conversion to surgery, progression of a tear on MRI re-examination, or severely abnormal International Knee Documentation Committee (IKDC) scores. Statistical analyses between the two groups were performed for demographic and radiographic characteristics. Multivariate regression analysis was used to determine the risk factors associated with worse outcomes.

Results

One-hundred and four knees in 96 patients were included in this study. After a mean follow-up of 76.9 ± 11.1 months, 25 knees (24.0%) met the overall failure criteria. Multivariate regression analysis demonstrated that age and the presence of intrameniscus signals increased the risk of nonoperative management failure. The clinical criterion of age > 37.5 years combined with the imaging criterion of the presence of intrameniscal signals predicted conservative treatment failure of symptomatic intact DLM with a sensitivity of 0.87 and a specificity of 0.91.

Conclusion

Twenty-five (24.0%) knees that underwent nonsurgical treatment met the overall failure criteria after a mean follow-up of 76.9 months. With increased age and the presence of intrameniscal signals, the nonoperative results become worse.

Level of evidence

III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

The data of this study are not openly available due to the protection of patients’ privacy and are available from the corresponding author upon reasonable request.

Abbreviations

DLM:

Discoid lateral meniscus

BMI:

Body mass index

MRI:

Magnetic resonance imaging

ROC:

Receiver operating characteristic

IKDC:

International Knee Documentation Committee

CI:

Confidence interval

ICC:

Intraclass correlation coefficient

References

  1. Araki Y, Yamamoto H, Nakamura H, Tsukaguchi I (1994) MR diagnosis of discoid lateral menisci of the knee. Eur J Radiol 18:92–95. https://doi.org/10.1016/0720-048x(94)90271-2

    Article  CAS  PubMed  Google Scholar 

  2. Bisicchia S, Botti F, Tudisco C (2018) Discoid lateral meniscus in children and adolescents: a histological study. J Exp Orthop 5:39. https://doi.org/10.1186/s40634-018-0153-5

    Article  PubMed  PubMed Central  Google Scholar 

  3. Campbell AL, Pace JL, Mandelbaum BR (2023) Discoid lateral meniscus. Curr Rev Musculoskelet Med 16:154–161. https://doi.org/10.1007/s12178-023-09824-4

    Article  PubMed  PubMed Central  Google Scholar 

  4. Chen L, Zheng JJY, Li G, Yuan J, Ebert JR, Li H, Papadimitriou J, Wang Q, Wood D, Jones CW, Zheng M (2020) Pathogenesis and clinical management of obesity-related knee osteoarthritis: impact of mechanical loading. J Orthop Translat 24:66–75. https://doi.org/10.1016/j.jot.2020.05.001

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Fu D, Guo L, Yang L, Chen G, Duan X (2014) Discoid lateral meniscus tears and concomitant articular cartilage lesions in the knee. Arthroscopy 30:311–318. https://doi.org/10.1016/j.arthro.2013.11.029

    Article  PubMed  Google Scholar 

  6. Hesse DG, Finlayson CJ, Gladstein AZ, Samet JD (2021) Pediatric discoid meniscus: can magnetic resonance imaging features coupled with clinical symptoms predict the need for surgery? Pediatr Radiol 51:1696–1704. https://doi.org/10.1007/s00247-021-05063-2

    Article  PubMed  Google Scholar 

  7. Irrgang JJ, Ho H, Harner CD, Fu FH (1998) Use of the International Knee Documentation Committee guidelines to assess outcome following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 6:107–114. https://doi.org/10.1007/s001670050082

    Article  CAS  PubMed  Google Scholar 

  8. Jeon SW, Choi CH, Jung M, Chun YM, Kim SJ, Jin S, Kim SH (2019) The fate of the contralateral knee in patients with a lateral discoid meniscus. Arthroscopy 35:500–506. https://doi.org/10.1016/j.arthro.2018.07.045

    Article  PubMed  Google Scholar 

  9. Kleinhans KL, Jackson AR (2018) Hydraulic permeability of meniscus fibrocartilage measured via direct permeation: effects of tissue anisotropy, water volume content, and compressive strain. J Biomech 72:215–221. https://doi.org/10.1016/j.jbiomech.2018.03.011

    Article  PubMed  Google Scholar 

  10. Kocher MS, Logan CA, Kramer DE (2017) Discoid lateral meniscus in children: diagnosis, management, and outcomes. J Am Acad Orthop Surg 25:736–743. https://doi.org/10.5435/jaaos-d-15-00491

    Article  PubMed  Google Scholar 

  11. Kose O, Celiktas M, Egerci OF, Guler F, Ozyurek S, Sarpel Y (2015) Prognostic factors affecting the outcome of arthroscopic saucerization in discoid lateral meniscus: a retrospective analysis of 48 cases. Musculoskelet Surg 99:165–170. https://doi.org/10.1007/s12306-015-0376-x

    Article  CAS  PubMed  Google Scholar 

  12. Laberge MA, Baum T, Virayavanich W, Nardo L, Nevitt MC, Lynch J, McCulloch CE, Link TM (2012) Obesity increases the prevalence and severity of focal knee abnormalities diagnosed using 3T MRI in middle-aged subjects–data from the osteoarthritis initiative. Skeletal Radiol 41:633–641. https://doi.org/10.1007/s00256-011-1259-3

    Article  PubMed  Google Scholar 

  13. Lee CR, Bin SI, Kim JM, Kim NK (2016) Magnetic resonance imaging findings in symptomatic patients after arthroscopic partial meniscectomy for torn discoid lateral meniscus. Arthroscopy 32:2366–2372. https://doi.org/10.1016/j.arthro.2016.04.012

    Article  PubMed  Google Scholar 

  14. 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 41:496–501. https://doi.org/10.1097/bpo.0000000000001907

    Article  PubMed  Google Scholar 

  15. Masquijo JJ, Bernocco F, Porta J (2019) Discoid meniscus in children and adolescents: correlation between morphology and meniscal tears. Rev Esp Cir Ortop Traumatol (Engl Ed) 63:24–28. https://doi.org/10.1016/j.recot.2018.08.002

    Article  CAS  PubMed  Google Scholar 

  16. Mochizuki T, Tanifuji O, Sato T, Watanabe S, Endo N (2021) Predictive factors for developing osteochondritis dissecans after surgery for discoid lateral meniscus are younger age and shorter meniscal width. Knee Surg Sports Traumatol Arthrosc 29:100–108. https://doi.org/10.1007/s00167-019-05750-6

    Article  PubMed  Google Scholar 

  17. Nesbitt DQ, Siegel DN, Nelson SJ, Lujan TJ (2021) Effect of age on the failure properties of human meniscus: high-speed strain mapping of tissue tears. J Biomech 115:110126. https://doi.org/10.1016/j.jbiomech.2020.110126

    Article  PubMed  Google Scholar 

  18. Papadopoulos A, Kirkos JM, Kapetanos GA (2009) Histomorphologic study of discoid meniscus. Arthroscopy 25:262–268. https://doi.org/10.1016/j.arthro.2008.10.006

    Article  PubMed  Google Scholar 

  19. Rai MF, Patra D, Sandell LJ, Brophy RH (2014) Relationship of gene expression in the injured human meniscus to body mass index: a biologic connection between obesity and osteoarthritis. Arthritis Rheumatol 66:2152–2164. https://doi.org/10.1002/art.38643

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Sasho T, Tsuruoka H, Saito M, Akagi R, Muramatsu Y, Mukoyama S, Yamaguchi S (2014) Time interval from initial surgery for torn discoid lateral meniscus to the contralateral knee surgery. Asia Pac J Sports Med Arthrosc Rehabil Technol 1:38–41. https://doi.org/10.1016/j.asmart.2013.12.007

    Article  Google Scholar 

  21. Stoller DW, Martin C, Crues JV 3rd, Kaplan L, Mink JH (1987) Meniscal tears: pathologic correlation with MR imaging. Radiology 163:731–735. https://doi.org/10.1148/radiology.163.3.3575724

    Article  CAS  PubMed  Google Scholar 

  22. Sun H, Zhang W, Liu F, Li D, Cai Z, Huang Z, Chen M, Lin Z, Xu J, Ma R (2022) Single-cell RNA sequencing reveals the cell types heterogenicity of human discoid lateral meniscus cells. J Cell Physiol 237:2469–2477. https://doi.org/10.1002/jcp.30704

    Article  CAS  PubMed  Google Scholar 

  23. Tapasvi S, Shekhar A, Eriksson K (2021) Discoid lateral meniscus: current concepts. J ISAKOS 6:14–21. https://doi.org/10.1136/jisakos-2017-000162

    Article  PubMed  Google Scholar 

  24. Tudisco C, Botti F, Bisicchia S (2021) Histological study of discoid lateral meniscus in children and adolescents: morphogenetic considerations. Joints 7:155–158. https://doi.org/10.1055/s-0041-1730979

    Article  PubMed  PubMed Central  Google Scholar 

  25. Watanabe M, Takeda S, Ikeuchi H (1974) Atlas of arthroscopy, 2nd edn. Igaku-Shoin Ltd, Tokyo

    Google Scholar 

  26. 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 30:1436–1442. https://doi.org/10.1007/s00167-021-06635-3

    Article  PubMed  Google Scholar 

  27. Yang S, Zhang S, Li R et al (2023) Chinese experts consensus and practice guideline on discoid lateral meniscus. Orthop Surg 15:915–929. https://doi.org/10.1111/os.13687

    Article  PubMed  PubMed Central  Google Scholar 

  28. Yang SJ, Li J, Xue Y, Zhang Z, Chen G (2021) Multivariate ordered logistic regression analysis of the postoperative effect of symptomatic discoid lateral meniscus. Arch Orthop Trauma Surg 141:1935–1944. https://doi.org/10.1007/s00402-021-03821-3

    Article  PubMed  PubMed Central  Google Scholar 

  29. Young RB (1889) The external semilunar cartilage as a complete disc. Mem Memo Anat 24:613

    Google Scholar 

  30. Zhang F, Bierma-Zeinstra SM, Oei EHG, Turkiewicz A, Englund M, Runhaar J (2017) Factors associated with meniscal body extrusion on knee MRI in overweight and obese women. Osteoarthr Cartil 25:694–699. https://doi.org/10.1016/j.joca.2016.12.001

    Article  CAS  Google Scholar 

  31. Zhang Z, Shang XK, Mao BN, Li J, Chen G (2019) Torn discoid lateral meniscus is associated with increased medial meniscal extrusion and worse articular cartilage status in older patients. Knee Surg Sports Traumatol Arthrosc 27:2624–2631. https://doi.org/10.1007/s00167-018-5287-6

    Article  PubMed  Google Scholar 

Download references

Funding

The authors did not receive support from any organization for the submitted work.

Author information

Authors and Affiliations

  1. Peking Union Medical College Hospital, Beijing, China

    Zhongyu Luo, Jun Qian, Xin Lu, Yu Fan, Xiao Chang, Bo Jiang & Mingxia Li

Authors
  1. Zhongyu Luo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jun Qian
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xin Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yu Fan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xiao Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bo Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mingxia Li
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study's conception and design. The database was provided by BJ. Experimental design, data collection, and analysis were performed by ZL, JQ, and XL. MRI image review was performed by XL, YF, and XC. The first draft of the manuscript was written by ZL and ML. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jun Qian.

Ethics declarations

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

Ethical approval was obtained from the ethics review committee of the Peking Union Medical College Hospital (ID: K23C2228).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Luo, Z., Qian, J., Lu, X. et al. Older age and the presence of intrameniscal signs are risk factors for nonsurgical treatment failure of symptomatic intact discoid lateral meniscus. Knee Surg Sports Traumatol Arthrosc 31, 5154–5161 (2023). https://doi.org/10.1007/s00167-023-07586-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-023-07586-7

Keywords

Search

Navigation