Surgical Management of Symptomatic Discoid Meniscus; Treatment modalities and functional outcomes

Öz

Purpose: The aim of the study was to evaluate the treatment modalities and the outcomes of patients operated on for discoid meniscus, and to compare the patients results with the existing literature. Materials and Methods: The study included 24 patients with discoid meniscus who underwent surgery between 2012 and 2022. Patients with incidentally discovered asymptomatic discoid meniscus were not included in the study. The diagnosis of the patients was made based on pain or mechanical symptoms accompanied by pain and X-Ray + MRI evaluation. Watanabe classification was used for macroscopic classification, and perioperative operation data of the patients were documented. The Oxford Knee Score was used for pre- and postoperative clinical evaluation. Results: The average age of the 24 patients was 18.1. Eleven patients had right kne discoid meniscus, and five had a bilateral discoid meniscus. The most common symptom was pain (79%). Lateral discoid meniscus was detected in 22 patients (91%). Watanabe Type 1 was the most commonly observed macroscopic variant (41%). Tear were found in 10 patients. All patients underwent arthroscopic saucerization. There was a significant improvement in the Oxford Knee scores in the first postoperative year. Discussion: The long-term outcomes of symptomatic discoid meniscus are quite good. Surgery should be recommended for patients with predominant mechanical symptoms and pain. Reshaping the meniscus and repairing instability are the main goals of surgery.

Anahtar Kelimeler

• Discoid meniscus
• Saucerization
• Treatment modalities

Semptomatik Diskoid Menisküsün Cerrahi Tedavisi; Tedavi modaliteleri ve fonksiyonel sonuçları

Öz

Amaç: Bu çalışmanın amacı diskoid menisküs nedeniyle opere edilen hastalarda uygulanan tedavi yöntemlerini sunmak, hasta sonuçlarını değerlendirmek ve sonuçları literatür ile karşılaştırmaktır. Araç ve yöntemler: Çalışmaya 2012-2022 yılları arasında opere edilen 24 diskoid menisküs hastası dahil edildi. İnsidental saptanan asemptomatik discoid menisküse sahip hastalar çalışmaya dahil edilmedi. Hastaların tanısı ağrı veya ağrının eşlik ettiği mekanik semptomlar ve X-Ray + Mr değerlendirme ile konuldu. Klinik değerlendirme de preop ve post op Oxford Knee skoru kullanıldı. Sonuçlar: 24 hastanın yaş ortalaması 18.1 idi. On bir hastada sağ diz diskoid menisküsü ve beşinde bilateral diskoid menisküs vardı. En sık semptom ağrıydı (%79). 22 hastada (%91) lateral diskoid menisküs saptandı. Watanabe Tip 1 en sık gözlenen makroskobik varyanttı (%41). 10 hastada yırtık saptandı. Tüm hastalara artroskopik saucerization uygulandı. Ameliyat sonrası 1. yılda Oxford Knee skorlarında anlamlı düzelme oldu. Tartışma: Semptomatik diskoid menisküsün uzun vadeli sonuçları oldukça iyidir. Baskın mekanik semptomları ve ağrısı olan hastalarda cerrahi önerilmelidir. Menisküsün yeniden şekillendirilmesi ve instabilitenin onarılması cerrahinin ana hedefleridir.

Anahtar Kelimeler

• Diskopid Menisküs
• Saucerization
• Tedavi yöntemleri

Kaynakça

1. 1. Kaplan EB. Discoid lateral meniscus of the knee joint. Nature, mechanism, and operative treatment. J Bone Joint Surg, A. 1957;39:77-87.
2. 2. Kocher MS, Logan CA, Kramer DE. Discoid lateral meniscus in children: diagnosis, management, and outcomes. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2017;25:736-43.
3. 3. Kocher MS, Klingele K, Rassman SO. Meniscal disorders: normal, discoid, and cysts. Orthopedic Clinics. 2003;34:329-40.
4. 4. Clark C, Ogden J. Development of the menisci of the human knee joint. Morphological changes and their potential role in childhood meniscal injury. JBJS. 1983;65:538-47.
5. 5. Nathan PA, Cole SC. 12 Discoid Meniscus: A Clinical and Pathologic Study. Clinical Orthopaedics and Related Research®. 1969;64:107-13.
6. 6. Atay OA, Pekmezci M, Doral MN, Sargon MF, Ayvaz M, Johnson DL. Discoid meniscus: an ultrastructural study with transmission electron microscopy. The American journal of sports medicine. 2007;35:475-8.
7. 7. Baratz ME, Fu FH, Mengato R. Meniscal tears: the effect of meniscectomy and of repair on intraarticular contact areas and stress in the human knee: a preliminary report. The American journal of sports medicine. 1986;14:270-5.
8. 8. Good CR, Green DW, Griffith MH, Valen AW, Widmann RF, Rodeo SA. Arthroscopic treatment of symptomatic discoid meniscus in children: classification, technique, and results. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2007;23:157-63. e1.

9. 9. Singh K, Helms CA, Jacobs MT, Higgins LD. MRI appearance of Wrisberg variant of discoid lateral meniscus. American Journal of Roentgenology. 2006;187:384-7.
10. 10. Kim S-J, Lee Y-T, Kim D-W. Intraarticular anatomic variants associated with discoid meniscus in Koreans. Clinical Orthopaedics and Related Research (1976-2007). 1998;356:202-7.
11. 11. Jordan MR. Lateral meniscal variants: evaluation and treatment. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 1996;4:191-200.
12. 12. Bae J-H, Lim H-C, Hwang D-H, Song J-K, Byun J-S, Nha K-W. Incidence of bilateral discoid lateral meniscus in an Asian population: an arthroscopic assessment of contralateral knees. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2012;28:936-41.
13. 13. Jordan MR. Lateral meniscal variants. Operative Techniques in Orthopaedics. 2000;10:234-44.
14. 14. Ahn JH, Lee YS, Ha HC, Shim JS, Lim KS. A novel magnetic resonance imaging classification of discoid lateral meniscus based on peripheral attachment. The American Journal of Sports Medicine. 2009;37:1564-9.
15. 15. Andrish JT. Meniscal injuries in children and adolescents: diagnosis and management. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 1996;4:231-7.
16. 16. Lau BC, Vashon T, Janghala A, Pandya NK. The sensitivity and specificity of preoperative history, physical examination, and magnetic resonance imaging to predict articular cartilage injuries in symptomatic discoid lateral meniscus. Journal of Pediatric Orthopaedics. 2018;38:e501-e6.
17. 17. Ahn JH, Kim K-I, Wang JH, Jeon JW, Cho YC, Lee SH. Long-term results of arthroscopic reshaping for symptomatic discoid lateral meniscus in children. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2015;31:867-73.
18. 18. Carter CW, Hoellwarth J, Weiss JM. Clinical outcomes as a function of meniscal stability in the discoid meniscus: a preliminary report. Journal of Pediatric Orthopaedics. 2012;32:9-14.
19. 19. Steinbacher G, Alentorn-Geli E, Alvarado-Calderón M, Barastegui D, Álvarez-Díaz P, Cugat R. Meniscal fixation is a successful treatment for hypermobile lateral meniscus in soccer players. Knee Surgery, Sports Traumatology, Arthroscopy. 2019;27:354-60.
20. 20. Gunes T, Bostan B, Erdem M, Asci M, Sen C, Kelestemur MH. Biomechanical evaluation of arthroscopic all-inside meniscus repairs. Knee Surgery, Sports Traumatology, Arthroscopy. 2009;17:1347-53.
21. 21. Beck JJ, Shifflett K, Greig D, Ebramzadeh E, Bowen RE. Defining a safe zone for all-inside lateral meniscal repairs in pediatric patients: A magnetic resonance imaging study. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2019;35:166-70.
22. 22. Feroe AG, Hussain ZB, Stupay KL, Kocher SD, Williams KA, Micheli LJ, et al. Surgical management of medial discoid meniscus in pediatric and adolescent patients. Journal of Pediatric Orthopaedics. 2021;41:e804-e9.
23. 23. Anderson KG, Carsen S, Stinson Z, Kushare I, Finlayson CJ, Nault M-L, et al. Medial Discoid Meniscus in Children: A Multicenter Case Series of Clinical Features and Operative Results. The American Journal of Sports Medicine. 2023;51:1171-6.