Midbody of the medial meniscus as a reference of preservation in partial meniscectomy for complete discoid lateral meniscus

Ahn²,

et al. 2020

J EXP ORTOP

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.

Section: Surgical Treatmentsupporting

confidence: 62%

Section: Introductionmentioning

confidence: 99%

Discoid lateral meniscus: importance, diagnosis, and treatment

Ahn²,

et al. 2020

J EXP ORTOP

“…Several clinical studies have shown that surgical treatment is the best therapy for discoid meniscus, as conservative medical treatment has no obvious effect (8). In the past, open surgery was the only solution to improve the shape and function of the meniscus.…”

Section: Discussionmentioning

confidence: 99%

Clinical efficacy of arthroscopy in the treatment of discoid meniscus injury and related risk factors for postoperative pain

Lu¹,

Chen²,

Hu³

et al. 2020

Ann Palliat Med

Background: Discoid meniscus is an abnormal meniscus of the knee joint. This study aimed to analyze the clinical efficacy of arthroscopy in the treatment of discoid meniscus injury, and determine the related risk factors for postoperative pain.Methods: A total of 80 patients with a discoid meniscus injury who were diagnosed and treated in our hospital from May 2017 to May 2018 were selected. According to the different surgical methods, they were divided into the study group (treated with meniscus plasty) or the control group (treated with subtotal meniscectomy). Knee joint motion and knee joint function were measured at 2, 6 and 12 weeks post-surgery.Knee joint function was measured using the Lysholm Knee Scoring Scale to determine clinical efficacy.Patients with an excellent and good rating were included in the painless group, and patients with an average and poor rating were included in the pain group. The risk factors for postoperative pain were analyzed using multivariate logistic regression.Results: Knee joint motion in the study group and the control group gradually increased and reached a peak 12 weeks after surgery (P<0.05), however, there was no significant difference between the 2 groups at each time point after surgery (P>0.05). The excellent and good rate, according to the Lysholm Knee Scoring Scale, was 84.62% in the study group and 84.38% in the control group. There was no significant difference between the 2 groups (P>0.05). There were differences between the pain group and the painless group in Watanabe classification, age, preoperative symptom time, cold compress, joint soft tissue injury, and postoperative weight-bearing time ≤1 week (P<0.05).Conclusions: Arthroscopy demonstrated efficacy for the treatment of patients with a discoid meniscus injury. Age, duration of preoperative symptoms, articular cartilage injury, postoperative cold compress and postoperative weight-bearing time were independent risk factors that affected postoperative pain after arthroscopic surgery. For high-risk patients, effective prevention and control measures should be taken to improve postoperative pain and promote the recovery of knee joint function.

“…At present, arthroscopic surgery is the primary method for treating symptomatic DLM, which mainly includes partial meniscectomy, partial meniscectomy and suture/ repair Figure 3, subtotal or total meniscectomy, and meniscal allograft transplantation. 1,132 Although there are some differences in the description of the partial meniscectomy of DLM in different literature, such as saucerization, meniscoplasty, or reshaping, all of them resect the redundant central region, retain appropriate width and thickness (usually the width is 6-10mm [165][166][167][168] ), and finally make the morphology of the remnant meniscus similar to that of NLM. 56,132,143 Partial meniscectomy is currently favored as the treatment for patients with symptomatic stable DLM.…”

Section: Methods and Choices Of Surgical Treatment Of Dlm And Its Les...mentioning

confidence: 99%

Chinese Experts Consensus and Practice Guideline on Discoid Lateral Meniscus

Yang

Zhang

et al. 2023

Orthopaedic Surgery

Discoid lateral meniscus (DLM) is the most common congenital variant of the lateral meniscus, which is prone to degeneration and lesions, and often leads to knee osteoarthritis. At present, there is no consensus on the clinical practice of DLM, and this expert consensus and practice guidelines on DLM was developed and approved by Chinese Society of Sports Medicine according to the Delphi method. Among 32 statements drafted, 14 statements were excluded for redundant information, and 18 statements achieved consensus. This expert consensus focused on the definition, epidemiology, etiology, classification, clinical manifestations, diagnosis, treatment, prognosis, and rehabilitation of DLM. Restoring the normal shape, retaining appropriate width and thickness, and ensuring the stability of the remnant meniscus is critical to sustaining the physiological function of the meniscus and preserving the knee. The partial meniscectomy with or without repair should be the first-line treatment when possible, given that the clinical and radiological long-term outcomes of total or subtotal meniscectomy are worse.