Discoid lateral meniscus: importance, diagnosis, and treatment.
ABSTRACT: Discoid lateral meniscus (DLM) is a common anatomic variant in the knee typically presented in young populations, with a greater incidence in the Asian population than in other populations. As DLM is a congenital anomaly, the ultrastructural features and morphology differ from those of the normal meniscus, potentially leading to meniscal tears. Snapping and pain are common symptoms, with occasional limitations of extension, in patients with DLM. Examination of the contralateral knee is necessary as DLM affects both knees. While simple radiographs may provide indirect signs of a DLM, magnetic resonance imaging (MRI) is essential for diagnosis and treatment planning. Although DLM was traditionally classified into three categories, namely, complete, incomplete, and Wrisberg DLM, a recent MRI classification provides useful information for surgical planning because the MRI classification was based on the peripheral detachment in patients with DLM, as follows: no shift, anterocentral shift, posterocentral shift, and central shift. Asymptomatic patients require close follow-up without surgical treatment, while patients with symptoms often require surgery. Total or subtotal meniscectomy, which has been traditionally performed, leads to an increased risk of degenerative arthritis; thus, partial meniscectomy is currently considered the treatment of choice for DLM. In addition to partial meniscectomy, meniscal repair of peripheral detachment is recommended for stabilization in patients with DLM to preserve the function of the meniscus. Previous studies have reported that partial meniscectomy with or without meniscal repair is effective and shows superior clinical and radiological outcomes to those of total or subtotal meniscectomy during the short- to long-term follow-up. Our preferred principle for DLM treatment is reduction, followed by reshaping with reference to the midbody of the medial meniscus and repair as firm as possible.
Project description:Large posterolateral corner loss type of discoid lateral meniscus tear is unsalvageable. Therefore, subtotal meniscectomy has been the only treatment option in this case. However, long-term results of subtotal or total meniscectomy have shown a high prevalence of early degenerative changes. Persistent symptoms, such as increased pain, snapping, giving way, locking, and limited extension, can be attributed to progressive loss of posterior tibial meniscal attachment and meniscal degeneration, especially in the posterior horn. The purpose of this technique-based article is to describe a partial repair, posterior horn repair augmented with the central portion of the discoid lateral meniscus that would have been removed if a subtotal meniscectomy were performed and bone marrow stimulation in the intercondylar notch to improve meniscal healing.
Project description:INTRODUCTION: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. PRESENTATION OF CASE: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. DISCUSSION AND CONCLUSION: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.
Project description:Meniscal tears are among the most commonly diagnosed knee injuries and often require surgical intervention. Understanding the types of meniscal tears and treatment options is paramount to caring for the young athlete. Sports medicine and arthroscopic physicians now recognize that meniscal preservation in the young athlete is essential to the long-term health and function of the knee. Although uncommon, the discoid lateral meniscus is more prone to injury because of its increased thickness and lack of blood supply. Because of the abnormal development, the peripheral attachments are frequently absent and instability often persists after a partial meniscectomy. If the instability is unrecognized during the initial treatment, a recurrence of pain and mechanical symptoms is likely and a subsequent subtotal meniscectomy may be the only treatment option. With increased awareness, arthroscopic saucerization accompanied by arthroscopically assisted inside-out meniscal repair is a preferable treatment option with an excellent outcome.
Project description:Preservation of the meniscus has been shown to influence the progression of degenerative changes of the knee. As more meniscus is preserved, the propensity for development of osteoarthritis is lessened. Surgical treatment of a torn discoid meniscus has typically been a subtotal meniscectomy or partial meniscectomy. Similar to tears of a normal meniscus, partial meniscectomy compared with subtotal meniscectomy of the discoid meniscus confers better long-term results. With the abnormal morphology predisposing the discoid meniscus to tearing, several characteristic tear patterns can be observed-the horizontal tear being commonly encountered. We present a technique that not only creates a more normal morphology of a discoid meniscus but also preserves the tissue by using an all-inside, intrameniscal repair technique. This technique restores the central rim of the meniscus in the setting of a horizontal cleavage plane, thus restoring a more normal meniscus morphology.
Project description:Although horizontal tears of the meniscus have historically been treated with partial meniscectomy due to poor vascularity within the tear, evidence suggests that repair of horizontal meniscal tears may be advantageous to partial meniscectomy. Furthermore, the addition of platelet-rich plasma has shown promise in improving meniscal healing. We present our technique of platelet-rich fibrin clot-augmented repair of horizontal cleavage meniscal tear.
Project description:The medial meniscus is crucial for knee homeostasis. Treating patients who have undergone a subtotal or total meniscectomy, or equivalent irreparable tear pattern, can be extremely challenging, especially in young, active patients. The importance of meniscal preservation has been reported by several authors. Meniscal repair is now widely accepted as the first surgical option for treating medial meniscal tears. Moreover, current guidelines recommend preserving as much meniscal tissue as possible. Treating a symptomatic medial meniscectomized knee is challenging because of limited surgical options. In this context, medial meniscal allograft transplantation arises as the preferred procedure. The purpose of this article was to detail the arthroscopic medial meniscal allograft transplantation technique with the use of 2 bone plugs.
Project description:Medial meniscal tears are among the most common injuries to the knee joint. Loss of the meniscus has been linked to increased contact pressures on the adjacent articular cartilage and progression of degenerative changes in the knee. A subset of tears known as "root tears" involves the insertion of the posterior horn of the meniscus to the bone. Arthroscopic partial meniscectomy for root tears led to undesirable outcomes, which prompted surgeons to explore restorative procedures. Multiple repair techniques have been presented with an emphasis placed on initial secure fixation and stimulation of potential healing. We present an arthroscopic-assisted technique for medial meniscal root repair with these goals in mind.
Project description:Horizontal cleavage and horizontal oblique meniscal tears have traditionally been treated with partial meniscectomy. Recent research has shown the deleterious long-term effects of meniscectomy in these patients regarding the development of osteoarthritis. Meniscal preservation is thus the preferred method of surgical treatment in patients with these tears. However, traditional repair techniques using inside-out sutures or suture anchor-based devices do not address the horizontally aligned nature of these particular tears and thus do not compress the meniscal tissue in the correct plane. The recent development of an arthroscopic suture-passing system now allows surgeons to place arthroscopic sutures in any pattern or direction. This allows surgeons to treat tears of any type with sutures ideally placed to repair the given tears. This Technical Note describes and demonstrates 2 all-suture, all-inside, arthroscopic meniscus repair techniques to treat these challenging horizontal tear types. The repair techniques are named the vertical lasso and horizontal lasso.
Project description:The meniscus is an essential structure for the knee functioning and survival. Meniscectomy is the most common surgical procedure in orthopaedic surgery. Following total or subtotal meniscectomy, meniscal allograft transplantation (MAT) should be considered in symptomatic active young patients. Several MAT techniques have been described in the literature as an attempt to restore normal knee kinematics and potentially decrease the risk of developing knee osteoarthritis. The purpose of this article is to describe in detail an efficient and reproducible all-arthroscopic MAT technique with bone plugs and preloaded sutures.
Project description:Meniscal injuries are extremely common in the general and athletic populations. The management strategy has switched from meniscectomy to meniscal-preserving techniques. It is nowadays extensively accepted that surgeons have to do their best to repair the meniscus and try to preserve as much tissue as possible. However, in many cases the tissue quality is poor and the tear pattern is complex. In such scenarios, meniscal repair has a lower success rate. In the present surgical technique, an arthroscopic all-inside circumferential-surrounding meniscal repair technique is presented. Any meniscal tissue or the meniscal rim is first debrided to a bleeding bed. Then, an all-inside device is used to create vertical sutures from capsule to capsule surrounding the entire meniscus (circumferential-surrounding). Care should be taken not to tighten the suture too much to avoid cutting the meniscal tissue. This easy and effective repair technique "packs" the meniscal tear fragments altogether and allows the surgeon to save the meniscus when facing with irreparable, degenerative, complex meniscus tears.