Factors influencing postoperative outcomes in patients with symptomatic discoid lateral meniscus

Abstract

Background: Due to its abnormal morphology and ultrastructure, discoid lateral meniscus (DLM) is prone to tear and degeneration, leading to clinical symptoms. Arthroscopy is the main treatment for symptomatic DLM; however, postoperative outcomes vary widely due to the effects of diverse factors. This research aims to explore the factors influencing postoperative outcomes of symptomatic DLM. Methods: Patients with DLM who underwent arthroscopic surgery at our hospital from 9/2008 to 9/2015 were enrolled according to the inclusion and exclusion criteria. Fourteen variables, including sex, body mass index (BMI) and other variables, were chosen as factors for study. Knee function was assessed using the International Knee Documentation Committee (IKDC) score. Univariate analyses (Mann-Whitney U test or Kruskall-Wallis rank sum test) and multivariate analyses (ordinal logistic regression) were used to identify the factors that influenced postoperative outcomes. P < 0.05 was considered statistically significant. Results: A total of 502 patients, including 353 females (70.3%) and 149 males (29.7%), were enrolled. The median IKDC score postoperatively (87.4; range, 41.4~97.7; IQR, 14.6) was higher than that preoperatively (57.6; range, 26.9 64.9; IQR, 9.7) (P < 0.001). Male sex was predictive of a higher IKDC score (P = 0.023, OR = 1.702). Compared with BMI ≥25 kg/m 2 , < 18.5 kg/m 2 was associated with better IKDC score (P = 0.026, OR = 3.016). Contrasting with age of onset ≥45 years, ≤14 years (P < 0.001, OR = 20.780) and 14~25 years (P < 0.001, OR = 8.516) were associated with better IKDC score. In comparison with symptoms duration> 24 months, IKDC scores for patients with symptoms duration ≤1 month (P = 0.001, OR = 3.511), 1~6 months (P < 0.001, OR = 3.463) and 6~24 months (P < 0.001, OR = 3.254) were significantly elevated. Compared to Outerbridge grade III~IV, no injury (P < 0.001, OR = 6.379) and grade I (P = 0.01, OR = 4.332) were associated with higher IKDC score. Conclusions: Arthroscopic treatment of symptomatic DLM is safe and effective, but its clinical efficacy is affected by many factors. Specifically, male sex, BMI < 18.5 kg/m 2 , age of onset < 25 years (especially < 14 years) and symptoms duration < 24 months are conducive to good postoperative outcomes. However, combined articular cartilage injury (Outbridge grade ≥ 2) reduces postoperative effect.

Guidelines on the Diagnosis and Treatment of Lateral Meniscal Lesions: A Consensus Statement by the Chinese Society of Sports Medicine

“…For meniscal tears lasting >24 months, the outcome of repair is uncertain because of cartilage degeneration. 237 If meniscal repair is not feasible, partial meniscectomy is performed. Total meniscectomy should be avoided in ACL-insufficient knees whenever possible, particularly in young patients.…”

“…For meniscal tears lasting >24 months, the outcome of repair is uncertain because of cartilage degeneration. 237 If meniscal repair is not feasible, When ACL injury is combined with lateral meniscal injuries, it is recommended to consider suturing the meniscus at the time of ACL reconstruction. Agree 36/37, 97.3% partial meniscectomy is performed.…”

Efficacy of short-term splint immobilization in the treatment of pediatric discoid lateral meniscus after saucerization management

“…A retrospective study with 502 patients showed that 4 variables, including male sex, BMI < 18.5 kg/m2, age of onset < 14 years, and symptoms duration < 24 months are related to good postoperative outcomes. [ 19 ] A previous study noted that obesity is associated with worsening knee function after arthroscopic partial meniscectomy, [ 20 ] and Kose et al [ 21 ] , showed that the age at the time of surgery was the only predictor that correlated with the Lysholm score at the final follow-up. In our work, there was no statistically significant difference between age, gender, BMI and symptom durations, thus potentially reducing outcome bias.…”

Menisco lateral discoide: revisión de la literatura

“…Es un factor de mal pronóstico para el resultado postoperatorio a largo plazo. 90 5. El tipo de menisco discoide y el tipo de lesión de acuerdo con la clasificación de O'Connor no tiene un efecto significativo en los resultados postoperatorios.…”