Arthroscopic treatment of the discoid lateral meniscus: Results of long-term follow-up

doi:10.1016/0749-8063(89)90004-2

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 5, Issue 2, June 1989, Pages 101-109

https://doi.org/10.1016/0749-8063(89)90004-2 Get rights and content

Abstract

Twenty-two patients (25 knees) were evaluated at an average follow-up of 54 months for clinical results of arthroscopic treatment of the discoid lateral meniscus syndrome. Discoid lateral menisci were classified arthroscopically as incomplete (92%) or complete (8%); no Wrisberg-type lesions were noted. Three patients (14%) had bilateral lesions. Symptomatic torn discoid menisci (20 knees) and torn discoid menisci with other significant symptomatic lesions (3 knees) underwent arthroscopic partial lateral meniscectomy utilizing the saucerization technique. Asymptomatic intact discoid menisci (2 knees) were left unresected. Using the knee scale of Ikeuchi, 55% of the symptomatic torn lesions were rated as excellent or good, 30% were rated as fair, and 15% were rated as poor at follow-up. Two of the 3 asymptomatic torn lesions were rated as excellent or good, as were both of the intact discoid lesions. Factors associated with an unsatisfactory rating at follow-up included preexistent degenerative changes, age, and sex. Duration of symptoms, type of discoid tear, and length of follow-up were not necessarily related to outcome results. Seven knees (28%) required arthroscopic reevaluation at a postoperative average of 23 months, documenting apparent physiologic function of the saucerized rim in 4 patients and failure of saucerization in 3 patients (12%). Overall, 14 of the 22 patients in this study (64%) resumed a normal activity level postoperatively, including 61% of those with symptomatic torn discoid lateral menisci.

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Cited by (110)

Arthroscopic Suture-Saucerization of Discoid Meniscus Allows Volume Conservation but Does Not Fully Restore Coverage
2023, Arthroscopy, Sports Medicine, and Rehabilitation
To quantify the effect of meniscoplasty suture-saucerization on volume and surface coverage of lateral discoid menisci.
This retrospective study included all consecutive 10 patients treated between 2014 and 2019 who had magnetic resonance imaging before and after surgery and 15 controls. The MITK 3M3 semiautomatic software was used to segment the meniscus and cartilage before and after surgery to measure the percentage of meniscus coverage on the tibial cartilage. Results are compared to control patients without knee pathology matched on sex and age with Student t test.
Discoid meniscus surface and volume before surgery were respectively 597 mm² (range, 550-887 mm²) and 2,822 mm³ (1,571-3,407 mm³), representing 74.5% (56%-89%) of the tibial cartilage surface. After surgery, it decreased to 422 mm² (229-569 mm²) and 1,235 mm³ (680-1,738 mm³), leading to 45.7% (22.5%-68.6%) coverage. In the control group, median surface was 457 mm² (314-641 mm²), volume was 1,321 mm³ (641-2,240 mm³), and tibial coverage was 55% (41%-77%). Altogether, meniscus volume after surgery was similar to normal, while coverage was significantly lower than controls (P = .04).
Meniscoplasty suture-saucerization procedure may allow meniscus sparing and restauration of a similar to normal meniscus volume. Meniscus surface and coverage are diminished compared to controls. Both surface and volume normalization is usually not achievable without decreasing the thickness of the rather thick discoid meniscus.
Both surface and volume normalization is usually not achievable without decreasing the thickness of thick discoid menisci.
Discoid Meniscus
2022, Clinics in Sports Medicine
Can an injured discoid lateral meniscus be returned to the correct anatomic position and size of the native lateral meniscus after surgery?
2021, Knee
No previous studies have compared the position and size of the remaining discoid lateral meniscus (DLM) with that of a normal lateral meniscus. This study aimed to evaluate the postoperative position and size of DLM compared with that of normal controls using magnetic resonance imaging (MRI).
This retrospective study involved 52 symptomatic complete type DLMs (discoid group) who underwent arthroscopic surgery and 50 normal controls (control group). Pre- and postoperative MRI evaluations, height, width, and relative percentage of extrusion (RPE) were assessed. Sagittal position parameters, including distances from articular cartilage center to anterior meniscus (CAMD) and from anterior articular cartilage margin to anterior horn (ACMD), were also assessed. Logistic regression analysis was performed to find factors with extrusion of remaining DLM.
The height of the discoid group was significantly lower than that of the control group (P = 0.000). RPE in the discoid group was significantly larger than in the control group (P = 0.005). Only CAMD and ACMD in the discoid group were different (positioned more anteriorly) from the control group (P = 0.000). Preoperative meniscal shift (odds ratio (OR): 12.448; P = 0.003) and operative technique, especially partial meniscectomy with repair (OR: 19.125; P = 0.000), were the major factors associated with extrusion.
The width of remaining DLM was comparable to that of normal controls, but the position was found to be more anterior and lateral than that of normal controls. Preoperative meniscal shift and combined meniscus repair were the major factors for smaller width and greater extrusion; thus, surgeons should address and counsel these factors before surgery.
Application of assisted portal under anterior horn of lateral meniscus for the treatment of discoid meniscus injury
2019, Knee
The assisted inferior anterolateral portal under anterior horn of the lateral meniscus (UAHLM portal) was applied to treat the lateral discoid meniscus injury conveniently and the clinical outcomes were evaluated.
A retrospective review was conducted on 60 patients who underwent arthroscopic surgery with a symptomatic discoid lateral meniscus. Normal anterolateral/anteromedial portals assisted with UAHLM portal (1-2 cm inferior to the anterolateral portal) were used. All patients were followed up for 24–48 months (median, 33 months) and evaluated by MRI images and clinical outcomes including clinical findings, Lysholm scores and IKDC scores.
After meniscus plasty with or without repair, most of the upper layer of lateral meniscuses was retained. A total of 54 patients (16 males and 38 females, 42 ± 17.8 years old) showed satisfactory clinical results without requiring reoperation after a median follow-up time of 33 months. At final follow-up, a full range of motion was achieved in all patients. MRI indicated the thickness of anterior horn of lateral meniscus was (5.38 ± 1.09 mm) before the operation and (4.04 ± 0.71 mm) after the operation at the 2-year follow-up; clinical outcomes were improved significantly than the baseline: positive McMurray test (50 vs. 2, P < 0.001), Lysholm score (64.9 ± 9.0 vs. 94.7 ± 4.9, P < 0.001), and IKDC score (54.4 ± 7.7 vs. 92.6 ± 4.3, P < 0.001). No significant complication was observed during the follow-up.
Thus, this technique with assisted UAHLM portal was convenient for arthroscopic discoid meniscus plasty and meniscus repair and served as an effective method in patients with a symptomatic discoid lateral.
Arthroscopic minimum saucerization and inferior-leaf meniscectomy for a horizontal tear of a complete discoid lateral meniscus: Report of two cases
2018, International Journal of Surgery Case Reports
Treatment of a horizontal tear of a complete discoid lateral meniscus (DLM) is still controversial. Preserving peripheral rim as a normal shape of the meniscus with single-leaf resection is a conventional treatment, however meniscal function could not be fully restored.
A 28-year old woman and a 34-year old woman experienced knee pain and had restricted knee extension. MRI showed horizontal tears of complete DLM in both patients. Arthroscopic minimum saucerization preserving more than 10 mm peripheral rim and inferior-leaf meniscectomy was performed. Two years after the surgery, the patient had no pain and no restriction of ROM. MRI showed the remaining superior-leaf maintained about half its width and no progression of coronal/sagittal extrusion.
As resecting more meniscal tissue has been considered to be a cause of degeneration or extrusion of the meniscus, arthroscopic minimum saucerization, preserving more meniscal tissue than standard saucerization, and inferior-leaf meniscectomy can be an alternative treatment option of horizontal tears of complete DLM with satisfying clinical and radiological results.
Does high location and thickness of the Wrisberg ligament affect discoid lateral meniscus tear type based on peripheral detachment?
2017, Knee
Citation Excerpt :
However, long-term outcomes of arthroscopic saucerization with or without meniscal repair for symptomatic DLM are still lacking [2,35]. In addition, re-tear rates in DLM cases have been reported as 5–12% [11,35–37]. Considering our results and previous reports, preoperative evaluation of WL on MRI scans in symptomatic DLM patients may be useful for predicting the possibility and direction of peripheral detachment if there is a vague finding of a tear on the MRI scan.
The aim of this study was to evaluate the relationship between discoid lateral meniscus (DLM) types based on peripheral detachment and anatomic features of Wrisberg ligament (WL) such as location and thickness based on magnetic resonance image (MRI).
A total of 322 knees in 292 patients were reviewed. Patients were divided into four DLM types according to peripheral detachment: no shift (type 1), anterocentral shift (type 2), posterocentral shift (type 3) and central shift (type 4). We reviewed all MRI concentrating on the presence, location (high or low location), running angle, thickness of WL, and WL/posterior cruciate ligament (PCL) thickness ratio. The relationship between DLM types and anatomic features of WL were analyzed using one-way analysis of variance and chi-square test.
According to DLM types based on peripheral detachment, 149 knees were type 1, 38 were type 2, 79 were type 3, and 56 were type 4. Among the 322 knees, 302 (93.8%) had WL on MRI. In DLM patients, type 3 showed a statistically significant (P < 0.001) relationship with high location of WL. In addition, type 3 had significantly larger (P < 0.0001) running angle of WL, thicker (P < 0.0001) WL, and higher (P < 0.0001) WL/PCL ratio compared to other types.
A high location and thick WL are related to posterocentral shift type of DLM based on peripheral detachment. Based on our results, the high location and thick WL might provide information to surgeons in predicting the direction of peripheral detachment in symptomatic DLM patients.

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Arthroscopic treatment of the discoid lateral meniscus: Results of long-term follow-up

Abstract

Arthroscopy

The external semilunar cartilage as a complete disc

Injuries to the knee joint

Lesions of the menisci: autopsy incidence in adults less than fifty-five years old

J Bone Joint Surg (Am)

Gross pathologic changes in the knee joint of the aged individual

Clin Orthop

The discoid lateral-meniscus syndrome

J Bone Joint Surg (Am)

Arthroscopic treatment of the discoid lateral meniscus: technique and long-term results

Clin Orthop

Atlas of arthroscopy

The pathology of the degenerated meniscus lesion

J Bone Joint Surg (Br)

Partial resection of the discoid lateral meniscus of the child's knee

J Bone Joint Surg (Br)

Arthroscopic meniscectomy of the discoid meniscus

Partial resection of the discoid meniscus in the child's knee

J Bone Joint Surg (Am)

Discoid lateral meniscus: diagnosis and treatment

Arthroscopy