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Dzidzishvili L, Allende F, Garcia JR, Poulson TA, Villarreal-Espinosa JB, Allahabadi S, Chahla J. Adults Have a Higher Incidence of Discoid Lateral Meniscus Tears Than Children-Adults Tend to Present With Complex Tears, While Horizontal Tear Patterns Are Frequently Encountered in Children: A Systematic Review. Arthroscopy 2025; 41:1195-1212. [PMID: 38735407 DOI: 10.1016/j.arthro.2024.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 04/14/2024] [Accepted: 04/18/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE To systematically review the available literature on patients with discoid lateral meniscus (DLM) with the goal of elucidating the rates and types of meniscal tears, clinical symptoms, treatment strategies, and postoperative clinical and radiographic outcomes in adult patients compared with a pediatric population. METHODS A literature search was performed using the PubMed, Embase, and Scopus databases from database inception to October 2023 according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Level of evidence I through IV human clinical studies evaluating rate and type of meniscal tears, clinical symptoms, patient-reported outcome measures, and postoperative radiographical assessments in patients with DLM were included. Comparisons were made by age younger and older than 16 years. Study quality was assessed using the Methodological Index for Non-Randomized Studies criteria. RESULTS Thirteen studies comprising 1,772 adult patients (>16 years old) with DLM (n = 1,856 knees) and 8 studies conducted in 304 pediatric patients (≤16 years old, n = 353 knees) were included. The reported mean age ranged from 22.4 to 45 years (mean follow-up, 24-157.5 months) in the adult group and from 5 to 12.9 years (mean follow-up, 37-234 months) in the pediatric DLM group. Among studies that reported on tear patterns, the majority of adult (n = 553; 96.5%) and pediatric (n = 163; 71.8%) patients had tears of the DLM. Complete DLM was the predominant type of DLM in both study groups (range in adults, 49.6% to 88%; range in pediatric patients, 19%-100%) with complex (46.1%; range, 5.3%-100%) and horizontal tears (18.2%; range, 20%-37.5%) being the most frequently described tear patterns in the adult and pediatric DLM groups, respectively. Pain was the predominant reported symptom in both study groups (range in adults, 12.1%-99.3%; range in pediatric patients, 32.4%-100%). Partial meniscectomy was the most frequently reported treatment option conducted in 334 adult knees (39.5%; range, 24.2%-100%) and 66 pediatric knees (63.5%; range, 15%-100%). Overall, improved postoperative clinical outcomes were reported in both study groups; however, radiographic progression of degenerative changes after subtotal meniscectomy was noted. CONCLUSIONS More adult patients with DLM present with tears in the literature compared with the pediatric population. Complex and horizontal tear patterns are the most frequently reported tears in adult and pediatric patients, respectively. Pain was the most relevant symptom in both study groups. There was generally significant improvement in postoperative clinical outcome scores; partial meniscectomy, however, remains the most frequently reported treatment option and is associated with fewer degenerative changes than in subtotal meniscectomy. LEVEL OF EVIDENCE Level IV, systematic review of Level I to IV studies.
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Affiliation(s)
- Lika Dzidzishvili
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.; Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A.; Department of Orthopaedic Surgery, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet, s/n, Barcelona, Spain
| | - Felicitas Allende
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.; Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
| | - Jose Rafael Garcia
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.; Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
| | - Trevor A Poulson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.; Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
| | - Juan B Villarreal-Espinosa
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.; Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
| | - Sachin Allahabadi
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.; Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A.; Houston Methodist Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.; Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A..
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Mohd Miswan MF, Alsagoff SNA, Yahaya MY, Sikkandar MF, Mohd Khalid MS. A Ring-Shaped Lateral Meniscus in an Anterior Cruciate Ligament Reconstruction Surgery. Cureus 2025; 17:e81729. [PMID: 40330346 PMCID: PMC12051721 DOI: 10.7759/cureus.81729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2025] [Indexed: 05/08/2025] Open
Abstract
The ring-shaped meniscus is a rare variant of meniscus anomalies. We report a case of a young man who experienced right knee instability following a sports-related injury. Clinical examination suggested an anterior cruciate ligament (ACL) tear, which was confirmed through imaging studies. Intra-operatively, an incidental finding revealed the presence of a ring-shaped lateral meniscus. We discuss the diagnostic features of this uncommon abnormality.
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Affiliation(s)
- Mohd Fairudz Mohd Miswan
- Sports Injury and Arthroscopy Unit, Department of Orthopaedics and Traumatology, Hospital Al-Sultan Abdullah, Puncak Alam, MYS
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh, MYS
| | - Sharifah Nor Amirah Alsagoff
- Sports Injury and Arthroscopy Unit, Department of Orthopaedics and Traumatology, Hospital Al-Sultan Abdullah, Puncak Alam, MYS
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh, MYS
| | - Mohd Yusoff Yahaya
- Sports Injury and Arthroscopy Unit, Department of Orthopaedics and Traumatology, Hospital Al-Sultan Abdullah, Puncak Alam, MYS
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh, MYS
| | - Mohamed Faizal Sikkandar
- Sports Injury and Arthroscopy Unit, Department of Orthopaedics and Traumatology, Hospital Al-Sultan Abdullah, Puncak Alam, MYS
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh, MYS
| | - Mohd Shukry Mohd Khalid
- Department of Radiology, Hospital Al-Sultan Abdullah, Puncak Alam, MYS
- Department of Radiology, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh, MYS
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Salman R, Amaral JZ, Schultz R, Diejomaoh R, Chandra K, Nguyen JC, Kushare I, McKay SD, Kan JH. Predictors of Discoid Morphology in Lateral Meniscal Tears: Introducing a Novel Meniscal Height Ratio. Acad Radiol 2025:S1076-6332(25)00094-7. [PMID: 39966076 DOI: 10.1016/j.acra.2025.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2024] [Revised: 01/27/2025] [Accepted: 01/28/2025] [Indexed: 02/20/2025]
Abstract
RATIONALE AND OBJECTIVES Identifying underlying discoid morphology in the setting of a lateral meniscal tear (LMT) can be challenging with no clear consensus on its definition. We aim to determine the magnetic resonance imaging (MRI) characteristics of discoid morphology, including a novel meniscal height ratio. METHODS A retrospective study of patients undergoing arthroscopic repair of isolated LMT between 2018 and 2023. MRIs were reviewed for the presence of discoid morphology, meniscocapsular ligaments and bone contusion, tear patterns, and lateral/medial meniscal height comparison to generate a ratio. Logistic regression was employed to assess predictive factors for discoid. Descriptive statistics were used to determine MRI diagnostic performance and receiver operating characteristic (ROC) curve to identify an optimal threshold for the meniscal height ratio. RESULTS We included 283 knees (mean age 14.9 years; 76% male); 112 with discoid morphology (group 1, G1), and 171 non-discoid (group 2, G2). Lateral bone contusions were less common in G1 than G2 (P<0.001). Meniscocapsular ligaments were identified in 68% of G1 versus 88% in G2 (P=0.001). G1 patients had a significantly greater meniscal height ratio compared with G2 (P<0.001). Female sex, younger age and horizontal tears were statistically significantly associated with G1. ROC analysis identified an optimal threshold of 1.21. Similar diagnostic accuracy for binomially determining underlying discoid morphology comparing a height ratio of 1.21 and lateral tibiofemoral meniscal coverage >50%. Selectively combining both parameters gives 100% specificity. CONCLUSION The meniscal height ratio plays a complementary role with other imaging and demographic findings to identify underlying discoid morphology.
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Affiliation(s)
- Rida Salman
- Department of Radiology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio (R.S.).
| | - Jason Zarahi Amaral
- Department of Orthopaedic Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas (J.A., R.S., R.D., R.D., K.C., I.K., S.D.M.)
| | - Rebecca Schultz
- Department of Orthopaedic Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas (J.A., R.S., R.D., R.D., K.C., I.K., S.D.M.); Department of Orthopaedic Surgery, Wayne State University, Detroit, Michigan (R.S.)
| | - Rioke Diejomaoh
- Department of Orthopaedic Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas (J.A., R.S., R.D., R.D., K.C., I.K., S.D.M.)
| | - Krishna Chandra
- Department of Orthopaedic Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas (J.A., R.S., R.D., R.D., K.C., I.K., S.D.M.)
| | - Jie C Nguyen
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (J.C.N.)
| | - Indranil Kushare
- Department of Orthopaedic Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas (J.A., R.S., R.D., R.D., K.C., I.K., S.D.M.)
| | - Scott D McKay
- Department of Orthopaedic Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas (J.A., R.S., R.D., R.D., K.C., I.K., S.D.M.)
| | - J. Herman Kan
- Edward B. Singleton Department of Radiology, Division of Body Imaging, Texas Children's Hospital and Baylor college of medicine, Houston, Texas (J.H.K.)
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Kim HY, Kim JM, Lee BS, Ryu J. Tear Pattern of the Complete Discoid Lateral Meniscus According to Meniscal Morphology. Orthop J Sports Med 2025; 13:23259671241306842. [PMID: 39991646 PMCID: PMC11843676 DOI: 10.1177/23259671241306842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 07/15/2024] [Indexed: 02/25/2025] Open
Abstract
Background The pattern and distribution of tears for the complete discoid lateral meniscus (DLM) are not well documented. Purpose To investigate the prevalence and pattern of tear types for the complete DLM using magnetic resonance imaging (MRI) and arthroscopic data. Study Design Cross-sectional study; Level of evidence, 3. Methods We reviewed consecutive series of 1219 patients (1406 knees) who underwent arthroscopic knee surgery for any pathology and were diagnosed with DLM between January 1998 and December 2022. After excluding cases with incomplete DLM (774 knees) and previous history of ipsilateral knee surgery (55 knees), a total of 486 patients (577 knees; mean age, 37.4 years; range, 5-76 years) with complete DLM were evaluated. Preoperative MRI and intraoperative arthroscopic findings were analyzed to classify tears into the following: peripheral tear-including bucket-handle tear; horizontal tear; radial tear; flap tear; and no tear. In addition, preoperative MRI was used to categorize 2 distinct morphological variants of complete DLM: (1) a block-shaped type with a thick blunt free edge; and (2) a wedge-shaped type with a tapering sharp free edge. Results When categorized by meniscal morphology, 435 knees (75.4%) were classified as block-type and 142 knees (24.6%) as wedge-type complete DLM. Peripheral tears (66.7%) were the most prevalent in the block type, followed by horizontal tears (22.5%) and radial tears (0.7%). In the wedge type, horizontal tears (43%) were observed most frequently, followed by radial tears (18.3%), peripheral tears (11.3%), and flap tears (5.6%). Conclusion A block-shaped morphology was the predominant form of complete DLM in this cohort of operatively treated patients. The wedge-type morphology had a distinctly different tear pattern, with horizontal tears being the most common. While the block type exhibited either a peripheral or horizontal tear, the wedge type was characterized by a greater variation in tear pattern.
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Affiliation(s)
- Ho Yeon Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Min Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Bum-Sik Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jaejung Ryu
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Araújo FF, Guimarães JB, da Cruz IAN, Morimoto LDR, Filho AGO, Nico MAC. Pediatric menisci: normal aspects, anatomical variants, lesions, tears, and postsurgical findings. Insights Imaging 2024; 15:295. [PMID: 39666127 PMCID: PMC11638453 DOI: 10.1186/s13244-024-01867-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Accepted: 11/20/2024] [Indexed: 12/13/2024] Open
Abstract
The reported incidence of meniscal tears in the pediatric age group has increased because of increased sports participation and more widespread use of MRI. Meniscal injury is one of the most commonly reported internal derangements in skeletally immature knees and can be associated with early degenerative joint disease leading to disability. The pediatric meniscus has particularities, and knowledge of normal anatomy, anatomical variations, and the patterns of meniscal injury in the pediatric age group is essential to provide a correct diagnosis. CRITICAL RELEVANCE STATEMENT: Accurate MRI interpretation of pediatric meniscal injuries is crucial. Understanding age-specific anatomy, vascularity, and variations can improve diagnostic precision, guiding targeted treatments to prevent early joint degeneration and disability. KEY POINTS: Meniscal lesions are common injuries in skeletally immature knees. Awareness of anatomical meniscus variants, patterns of injury, and associated injuries is essential. Meniscal tears in pediatric patients should be repaired if possible.
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Affiliation(s)
- Flávia Ferreira Araújo
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, São Paulo, Brazil.
| | - Júlio Brandão Guimarães
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, São Paulo, Brazil
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Kim JS, Kim JH, Choi MY, Ha JK, Baek SH, Chung KS. Incidence of symptomatic discoid meniscus in Korea: epidemiologic big data analysis from HIRA database. Knee Surg Relat Res 2024; 36:32. [PMID: 39456078 PMCID: PMC11512506 DOI: 10.1186/s43019-024-00234-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 09/19/2024] [Indexed: 10/28/2024] Open
Abstract
BACKGROUND There is a lack of evidence of the diagnosis and treatment-related epidemiological studies of symptomatic discoid meniscus. This study analyzed the national epidemiological data for discoid meniscus in South Korea. METHODS From 2011 to 2019, data related to the diagnosis and procedure codes of discoid meniscus were obtained from the Korean Health Insurance Review and Assessment Service database. All patients encoded as discoid meniscus were included. Data were extracted and further analyzed as follows: (1) the total number and the incidence (cases per 100,000) of discoid meniscus diagnosis per year, (2) sex distribution, (3) age distribution, (4) discoid meniscus ratio (total discoid meniscus coding per total meniscus injury coding), and (5) surgical procedures after discoid meniscus injury. RESULTS The total number of discoid meniscus diagnosed was 4576 in 2011 and increased to 6639 in 2019, representing a 45.1% increase. The incidence was 9.5 in 2011 and increased to 13.0 in 2019. Concerning sex, discoid meniscus was more common in females (55%) than in males (45%) over the study period. Regarding age, the peak age of discoid meniscus in 2011 was "under 19," whereas in 2019, the peak age was observed in the 50s. The discoid meniscus ratio range was 2.12-2.60% from 2011 to 2019. The total number of meniscectomy increased by 20% from 2000 in 2011 to 2475 in 2014. However, the total number of meniscus repairs was 318 in 2011 and increased to 502 in 2019, indicating an increase of 58%. CONCLUSIONS The total number and incidence of symptomatic discoid as well as the discoid meniscus ratio and the incidence of total discoid meniscus repair steadily increased from 2011 to 2019. The number of meniscus repair procedures increased more rapidly than that of meniscectomy. The current study helps understand the epidemiology of symptomatic discoid meniscus, its prevention, and cost-saving measures in South Korea.
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Affiliation(s)
- Jin Seong Kim
- Department of Physical Therapy, Ilsan Paik Hospital, College of Medicine, Inje University, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Jung Hoon Kim
- Sports and Exercise Medicine Lab, Korea Maritime and Ocean University, Busan, Republic of Korea
| | - Moon Young Choi
- Department of Physical Education, College of Humanities, Daegu University, Gyeongsan-si, Gyeongsangbuk-do, Republic of Korea
| | - Jeong Ku Ha
- Department of Orthopedic Surgery, Jump Orthopedic Clinic, Seoul, Republic of Korea
| | - Seung Hun Baek
- Department of Orthopedic Surgery, College of Medicine, Hanyang University Hospital at Guri, 153, Gyeongchun-ro, Guri-si, Gyeonggi-do, Republic of Korea
| | - Kyu Sung Chung
- Department of Orthopedic Surgery, College of Medicine, Hanyang University Hospital at Guri, 153, Gyeongchun-ro, Guri-si, Gyeonggi-do, Republic of Korea.
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Parkar AP, Adriaensen MEAPM. ESR essentials: MRI of the knee-practice recommendations by ESSR. Eur Radiol 2024; 34:6590-6599. [PMID: 38536461 PMCID: PMC11399221 DOI: 10.1007/s00330-024-10706-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 05/07/2024]
Abstract
Many studies and systematic reviews have been published about MRI of the knee and its structures, discussing detailed anatomy, imaging findings, and correlations between imaging and clinical findings. This paper includes evidence-based recommendations for a general radiologist regarding choice of imaging sequences and reporting basic MRI examinations of the knee. We recommend using clinicians' terminology when it is applicable to the imaging findings, for example, when reporting meniscal, ligament and tendon, or cartilage pathology. The intent is to standardise reporting language and to make reports less equivocal. The aim of the paper is to improve the usefulness of the MRI report by understanding the strengths and limitations of the MRI exam with regard to clinical correlation. We hope the implementation of these recommendations into radiological practice will increase diagnostic accuracy and consistency by avoiding pitfalls and reducing overcalling of pathology on MRI of the knee. CLINICAL RELEVANCE STATEMENT: The recommendations presented here are meant to aid general radiologists in planning and assessing studies to evaluate acute and chronic knee findings by advocating the use of unequivocal terminology and discussing the strengths and limitations of MRI examination of the knee. KEY POINTS: • On MRI, the knee should be examined and assessed in three orthogonal imaging planes. • The basic general protocol must yield T2-weighted fluid-sensitive and T1-weighted images. • The radiological assessment should include evaluation of ligamentous structures, cartilage, bony structures and bone marrow, soft tissues, bursae, alignment, and incidental findings.
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Affiliation(s)
- Anagha P Parkar
- Radiology Department, Haraldsplass Deaconess Hospital, Postboks 6165 Posterminalen, 5892, Bergen, Norway.
- Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Postboks 7804, 5021, Bergen, Norway.
| | - Miraude E A P M Adriaensen
- Department of Radiology, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, the Netherlands
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Kemmeren LA, Oei EH, van Middelkoop M, Eygendaal D, Piscaer TM. Prevalence of Abnormalities and Normal Variants in the Adolescent Knee on MRI in a Population-Based Cohort of 3800 Knees. Am J Sports Med 2024; 52:3039-3045. [PMID: 39279277 PMCID: PMC11529136 DOI: 10.1177/03635465241277162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 07/22/2024] [Indexed: 09/18/2024]
Abstract
BACKGROUND Many adolescents experience knee pain, and only some undergo detailed imaging. In this population, the prevalence of abnormalities and normal variants on magnetic resonance imaging (MRI) scans is unknown. PURPOSE To investigate the prevalence of abnormalities and normal variants of the knee on MRI scans and their relationship with participant characteristics in the general young adolescent population. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS This study was part of an open population-based cohort study that focuses on health, growth, and development from fetal life until adulthood. Between 2017 and 2020, adolescents aged 12 to 15 years underwent MRI of both knees. These MRI scans were assessed in a standardized way for abnormalities and normal variants to determine their prevalence. Logistic regression was used to analyze the presence of abnormalities and normal variants in relation to sex, height, weight, body mass index-standard deviation (BMI-SD), and ethnicity. RESULTS A total of 1910 participants (median age, 13.5 years; interquartile range, 13.4-13.7 years; 52% girls) were included in this study. Of them, 370 (19.4%) participants had at least 1 abnormality or normal variant. Bone marrow edema around the knee was the most prevalent finding, affecting 140 (7.3%) participants. In 107 (5.6%) participants, nonossifying fibromas were found. A total of 43 (2.3%) participants had characteristics of Osgood-Schlatter disease, 16 (0.8%) showed characteristics of Sinding-Larsen-Johansson syndrome, and osteochondritis dissecans was found in 13 (0.7%) participants. Variants such as discoid menisci were found in 40 (2.1%) participants and a bipartite patella in 21 (1.1%) participants. There were multiple associations between abnormalities or variants and participant characteristics, including bone marrow edema being more often present in boys (odds ratio [OR], 2.44; 95% CI, 1.69-3.52) and those with a lower BMI-SD (OR, 0.85; 95% CI, 0.73-0.98). Osgood-Schlatter and osteochondritis dissecans were more often present in boys (OR, 4.21 [95% CI, 2.01-8.85] and OR, 13.18 [95% CI, 1.71-101.58], respectively). Discoid menisci were associated with a non-Western ethnicity (OR, 2.06; 95% CI, 1.07-3.96) and higher BMI-SD (OR, 2.34; 95% CI, 1.76-3.11). CONCLUSION Abnormalities and normal variants on MRI scans of the knees are common in adolescents. Physicians who are involved in the treatment of adolescents with knee pain need to be aware of this prevalence so that these children will not be overtreated or misdiagnosed.
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Affiliation(s)
- Laura A.M. Kemmeren
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Edwin H.G. Oei
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Denise Eygendaal
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Tom M. Piscaer
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
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Sheasley JA, Kirby JC, Niu EL, Gopalan M, Carsen S, Stinson ZS, Finlayson CJ, Nault ML, Lee RJ, Haus BM, Green DW, Schlechter JA, Beck J, Heyworth B, Stavinoha T, Nguyen JC, Schmale GA. Characteristics and Outcomes of Operatively Treated Discoid Lateral Meniscus in Pediatric and Young Adult Patients: A Multicenter Study. Am J Sports Med 2024; 52:2758-2763. [PMID: 39222125 DOI: 10.1177/03635465241272393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
BACKGROUND Discoid lateral meniscus (DLM) is the most common congenital abnormality of the meniscus. Tears are common; treatment is frequently not definitive, often requiring reoperation. PURPOSE To report the clinical manifestations, physical characteristics, operative treatments and findings, complications, and reoperations of DLM in pediatric patients from multiple centers across North America. STUDY DESIGN Case series; Level of evidence, 4. METHODS Consecutive patients who underwent treatment for symptomatic DLM at 9 institutions between 2000 and 2020 were included. Patient data, presenting symptoms and signs, surgical findings, treatments rendered, and postoperative complications, including reoperation rates, were collected. Means with ranges and counts with proportions are reported for continuous and categorical variables, respectively, and comparisons were made using either the chi-square or Fisher exact test. RESULTS In total, 784 patients (867 knees) were included with a mean age at diagnosis of 12 years (range, 1-22 years) and a mean follow-up of 22.6 months (range, 0-154 months). Common preoperative symptoms were locking (33%) and snapping (30%). At surgery, tears in the DLM were present in 647 knees (594 patients [76%]); 95 knees (11%) had multiple tears; and in 140 knees, tears extended into >1 zone. Tears, when present, were more common within the posterior horn (41%) or body (34%) than the anterior horn (25%). Peripheral rim instability was reported in 241 knees (28%). Significantly more knees had instability posteriorly (15%; P = .0004) and anteriorly (9%; P = .0013) than along the body (3%). Tear type was most commonly complex (38%) or horizontal (34%). A total of 358 knees in 333 patients with tears (42% of all patients) underwent repair (55% of knees with tears). A total of 175 complications were reported, occurring in 139 knees in 134 patients (17%); 116 of these knees with complications (83%) had a single complication, while 23 (17%) had >1. Of the 784 patients, 105 (13%) underwent reoperation, undergoing 135 additional procedures related to their DLM. Of those, 60 (44%) were repeat arthroscopy and meniscal trim; 40 (30%), arthroscopy and meniscal repair; and 17 (13%), an articular cartilage procedure. CONCLUSION Locking and snapping were common presenting symptoms. Over three-quarters of patients had meniscal tears, which were most often complex and located posteriorly. Seventeen percent of patients experienced complications, and a sixth of patients with complications had >1. Reoperation was typically for persistent symptoms or meniscal retear.
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Affiliation(s)
| | | | - Emily L Niu
- Children's National Hospital, Washington, DC, USA
| | - Maya Gopalan
- Seattle Children's Hospital, Seattle, Washington, USA
| | - Sasha Carsen
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - Craig J Finlayson
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Marie-Lyne Nault
- CHU St. Justine, Université de Montréal, Montréal, Quebec, Canada
| | - R Jay Lee
- Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Brian M Haus
- UC Davis Children's Hospital, Sacramento, California, USA
| | | | - John A Schlechter
- Pediatric Orthopedic Specialists Orange County, Children's Hospital of Orange County, Orange, California, USA
| | | | | | - Tyler Stavinoha
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jie C Nguyen
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Gregory A Schmale
- Seattle Children's Hospital, Seattle, Washington, USA
- Investigation performed at Seattle Children's Hospital, Seattle, Washington, USA
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Yaya-Quezada C, Fanney L, Patel V, Taragin BH, Williams BA, Simoni P, Nguyen JC. Imaging of the Pediatric Knee. Semin Musculoskelet Radiol 2024; 28:462-476. [PMID: 39074728 DOI: 10.1055/s-0044-1786152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
During normal development, imaging findings in the immature knee joint may mimic pathology or indicate transient sites of weakness, prone to injury. This article reviews the development of the knee joint, age- and maturation-dependent imaging considerations, and various developmental variants that can be encountered, subdivided into those that involve the tibiofemoral and patellofemoral compartments, soft tissues, and osseous components. The tibiofemoral compartment section reviews the focal periphyseal edema zone (FOPE), ossification variants of the femoral condyles, distal femoral metaphyseal cortical irregularity from periosteal traction, and the metaphyseal subperiosteal stripe, which should be distinguished from pathologic mimickers such as endochondral ossification dysfunction, osteochondritis dissecans (OCD), fibroosseous lesion, periosteal and subcortical pathologies. The patellofemoral compartment section includes a review of partite patella, dorsolateral defect, variant trochlear morphology, and maturation-dependent sites of transient weakness that are prone to injury from repetitive overuse (Sinding-Larsen-Johansson syndrome and Osgood-Schlatter disease) and avulsion fractures (patellar sleeve and tibial tubercle avulsions). Finally, soft tissue (discoid lateral meniscus, meniscal flounce, anterior cruciate ligament variants) and osseous components (meniscal ossicle, fabella, and cyamella) are reviewed.
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Affiliation(s)
- Carlos Yaya-Quezada
- Section of Musculoskeletal Imaging, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lewis Fanney
- Section of Musculoskeletal Imaging, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Eastern Virginia Medical School, Norfolk, Virginia
| | - Vandan Patel
- Section of Musculoskeletal Imaging, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Drexel University College of Medicine, Philadelphia, Pennsylvania
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Benjamin H Taragin
- Section of Musculoskeletal Imaging, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brendan A Williams
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Paolo Simoni
- Queen Fabiola Children's University Hospital, Brussels, Belgium
| | - Jie C Nguyen
- Section of Musculoskeletal Imaging, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Jin J, Xu X, Piao M, Sun W, Pan G, Liu Y. Clinical efficacy and pain follow-up after arthroscopic discoid meniscoplasty of the knee: a retrospective study. BMC Musculoskelet Disord 2024; 25:570. [PMID: 39034413 PMCID: PMC11265089 DOI: 10.1186/s12891-024-07683-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 07/11/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND To assess the viability and efficiency of performing arthroscopic meniscoplasty in treating discoid meniscus (DM) in the knee joint. METHODS A total of 29 patients diagnosed with symptomatic lateral DM between October 2014 and December 2019 were included in the study. Among them, 7 patients with intact DM underwent arthroscopic discoid meniscoplasty (group A), while 22 patients with torn DM received arthroscopic DM plasty along with repair and suturing (group B). Both Visual Analog Scale (VAS) score and Lysholm score assessments were conducted preoperatively and postoperatively. RESULT The favorable and acceptable outcome rate was 85.71% in group A and 95.45% in group B (P > 0.05). The VAS scores post-operatively at each follow-up time point were consistently lower compared to pre-operative values, while the Lysholm knee function scores showed improvement. There were no significant differences in VAS score and Lysholm score between group A and group B at different stages (P > 0.05). Both surgical techniques (discoid meniscoplasty and discoid meniscoplasty combined with repair and suture) showed significant improvement in postoperative VAS score and Lysholm score, but there was no difference in outcomes between the two groups. CONCLUSION Overall, the two surgical techniques studied in this study (discoid meniscoplasty and discoid meniscoplasty combined with repair and suture) produced similar results in terms of pain reduction and improved knee function.
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Affiliation(s)
- Jingri Jin
- Department of Joint Surgery, The Affiliated Hospital of Yanbian University, 1327 Juzi Street, Yanji City, Jilin Province, 133000, P.R. China
| | - Xiaodan Xu
- Department of Operating Room, The Affiliated Hospital of Yanbian University, Yanji City, Jilin Province, China
| | - Mingjun Piao
- Department of Joint Surgery, The Affiliated Hospital of Yanbian University, 1327 Juzi Street, Yanji City, Jilin Province, 133000, P.R. China
| | - Weize Sun
- Department of Joint Surgery, The Affiliated Hospital of Yanbian University, 1327 Juzi Street, Yanji City, Jilin Province, 133000, P.R. China
| | - Guangzhi Pan
- Department of Joint Surgery, The Affiliated Hospital of Yanbian University, 1327 Juzi Street, Yanji City, Jilin Province, 133000, P.R. China
| | - Yanqun Liu
- Department of Joint Surgery, The Affiliated Hospital of Yanbian University, 1327 Juzi Street, Yanji City, Jilin Province, 133000, P.R. China.
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Albishi W, Albaroudi A, Alaseem AM, Aljasser S, Alshaygy I, Addar A. Discoid meniscus: Treatment considerations and updates. World J Orthop 2024; 15:520-528. [PMID: 38947261 PMCID: PMC11212537 DOI: 10.5312/wjo.v15.i6.520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/07/2024] [Accepted: 04/23/2024] [Indexed: 06/12/2024] Open
Abstract
A discoid meniscus is a morphological abnormality wherein the meniscus loses its normal 'C' shape. Although most patients are asymptomatic, patients might still present with symptoms such as locking, pain, swelling, or giving way. Magnetic resonance imaging is usually needed for confirmation of diagnosis. Based on a constellation of factors, including clinical and radiological, different approaches are chosen for the management of discoid meniscus. The purpose of this review is to outline the treatment of discoid meniscus, starting from conservative approach, to the different surgical options for this condition. The PubMed and Google Scholar databases were used for this review. Studies discussing the treatment of discoid meniscus from 2018 to 2023 were searched. Initially there were 369 studies retrieved, and after removal of studies using the exclusion criteria, 26 studies were included in this review. Factors such as stability, presence of tear, and morphology can help with surgical planning. Many approaches have been used to treat discoid meniscus, where the choice is tailored for each patient individually. Postoperatively, factors that may positively impact patient outcomes include male sex, body mass index < 18.5, age at symptom onset < 25 years, and duration of symptoms < 24 months. The conventional approach is partial meniscectomy with or without repair; however, recently, there has been an increased emphasis on discoid-preserving techniques such as meniscoplasty, meniscopexy, and meniscal allograft transplantation.
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Affiliation(s)
- Waleed Albishi
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia
| | - Amjad Albaroudi
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia
| | - Abdulrahman M Alaseem
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia
| | - Sarah Aljasser
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia
| | - Ibrahim Alshaygy
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia
| | - Abdullah Addar
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia
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Cho JH, Nam HS, Park SY, Ho JPY, Lee YS. Arthroscopic Meniscal Repair and Meniscectomy for Adult Discoid Lateral Meniscus Results in Progression to Valgus Alignment and Lateral Compartment Degeneration Compared With Nonoperative Treatment and Nondiscoid Lateral Meniscus. Arthroscopy 2024; 40:1223-1233. [PMID: 37717929 DOI: 10.1016/j.arthro.2023.08.085] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 09/19/2023]
Abstract
PURPOSE To analyze the effect of the arthroscopic meniscal procedure in adult discoid lateral meniscus (DLM) according to the age and meniscal-preserving by making comparisons with the nondiscoid lateral meniscus (N-DLM). METHODS From March 2014 to October 2020, a comparative analysis was performed in adults with DLM who underwent arthroscopic meniscal procedures (operative DLM: 134 knees), nonoperative treatment (nonoperative DLM: 56 knees), and adult N-DLM who underwent arthroscopic meniscal procedures (operative N-DLM: 64 knees). These patients were between 20 and 65 years old and completed a minimum follow-up of 2 years. Patients with DLM who underwent arthroscopic procedure were divided into subgroups according to age and extent of the meniscal-preserving. The following parameters were assessed and compared between the groups: (1) coronal limb alignment, (2) osteoarthritis grade, and (3) clinical outcomes and the minimal clinically important difference. RESULTS The coronal limb alignment was significantly changed to valgus in the order of operative DLM, N-DLM, and nonoperative DLM (Δ mechanical hip-knee-ankle angle: 3.23 ± 1.85 vs 1.35 ± 1.03° vs -0.57 ± 1.88°; P < .05). Operative DLM showed most prominent osteoarthritic change in the lateral compartment, followed by the N-DLM and nonoperative DLM groups (40.3% vs 17.2% vs 5.3%; P < .05). These changes in operative DLM were more prominent in older adults who underwent meniscal-sacrificing procedures and resulted in less-satisfactory clinical outcomes (all P < .05). CONCLUSIONS Arthroscopic surgery for adult DLM resulted in progression to valgus alignment and lateral compartment degeneration compared with nonoperative treatment and arthroscopic surgery of the adult N-DLM. Old ager and having a meniscal-sacrificing procedure showed more rapid radiographic changes and lower clinical outcomes. LEVEL OF EVIDENCE Level III, retrospective comparison study.
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Affiliation(s)
- Joon Hee Cho
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | - Hee Seung Nam
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | - Seong Yun Park
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | - Jade Pei Yuik Ho
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | - Yong Seuk Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea.
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Qiao Y, Zhang X, Wu C, Xu C, Sun Z, Zhao J, Zhao S. Prevalence and a correlation analysis of discoid meniscus and femoral trochlear dysplasia. BMC Musculoskelet Disord 2023; 24:923. [PMID: 38037030 PMCID: PMC10687981 DOI: 10.1186/s12891-023-06958-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/12/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Discoid meniscus (DM) and femoral trochlear dysplasia (FTD) are common knee disorders. Both as congenital malformation, whether there is a connection between them is unclear and the research on their prevalence in the general population is inadequate. This study aimed to investigate the prevalence of FTD and DM in the general population through a large sample size, and to explore the relationship between them. STUDY DESIGN Retrospective study. METHODS Patients undergoing knee magnetic resonance imaging (MRI) examinations at our outpatient clinic were screened and 1003 patients were enrolled in DM group with 989 patients in non-DM (NDM) group. The type of DM and FTD was classified with Watanabe classification and Dejour's classification, respectively. The prevalence of FTD and DM in the general population and the relationship between them were evaluated. RESULTS The prevalence of DM and FTD was 10.0% and 14.5%, respectively. The overall percentage of FTD was higher in DM group (P < 0.001). The DM group has a higher percentage of all types of FTD except type D (P < 0.05), and a higher percentage of both low- and high-grade FTD (P < 0.001). There were 633 cases of type I DM and 370 cases of type II DM. The overall percentage of FTD was not significantly different between the two types (P = 0.106). No significant difference was detected for all types of FTD except type B (P < 0.05). The Type I DM group has a significant higher percentage of high-grade FTD than Type II group (P < 0.05). CONCLUSION Patients with a DM are more likely to have FTD regardless of the type of DM, while those with a type I DM are more prone to have a high grade FTD.
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Affiliation(s)
- Yi Qiao
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, China
| | | | - Chenliang Wu
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, China
| | - Caiqi Xu
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, China
| | - Zhenkui Sun
- Department of Medical Imaging and Nuclear Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, China.
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, China.
| | - Song Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, China.
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Members of the SCORE Quality Improvement Registry, Adsit E, Albright J, Algan S, Beck J, Bowen RE, Brey J, Marc Cardelia J, Clark C, Coello P, Crepeau A, Edmonds E, Ellington M, Ellis HB, Fabricant PD, Frank JS, Ganley TJ, Green DW, Gupta A, Heyworth B, Kemper WC, Latz K, Mansour A, Mayer S, McKay SD, Milewski MD, Niu E, Pacicca DM, Parikh SN, Pupa L, Rhodes J, Saper M, Schmale GA, Schmitz M, Shea K, Silverstein RS, Storer S, Wilson PL. Relationship Between Age and Pathology With Treatment of Pediatric and Adolescent Discoid Lateral Meniscus: A Report From the SCORE Multicenter Database. Am J Sports Med 2023; 51:3493-3501. [PMID: 37899536 PMCID: PMC10623608 DOI: 10.1177/03635465231206173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 07/20/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Surgical treatment options of discoid lateral meniscus in pediatric patients consist of saucerization with or without meniscal repair, meniscocapular stabilization, and, less often, subtotal meniscectomy. PURPOSE To describe a large, prospectively collected multicenter cohort of discoid menisci undergoing surgical intervention, and further investigate corresponding treatment of discoid menisci. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A multicenter quality improvement registry (16 institutions, 26 surgeons), Sports Cohort Outcomes Registry, was queried. Patient characteristics, discoid type, presence and type of intrasubstance meniscal tear, peripheral rim instability, repair technique, and partial meniscectomy/debridement beyond saucerization were reviewed. Discoid meniscus characteristics were compared between age groups (<14 and >14 years old), based on receiver operating characteristic curve, and discoid morphology (complete and incomplete). RESULTS In total, 274 patients were identified (mean age, 12.4 years; range, 3-18 years), of whom 55.6% had complete discoid. Meniscal repairs were performed in 55.1% of patients. Overall, 48.5% of patients had rim instability and 36.8% had >1 location of peripheral rim instability. Of the patients, 21.5% underwent meniscal debridement beyond saucerization, with 8.4% undergoing a subtotal meniscectomy. Patients <14 years of age were more likely to have a complete discoid meniscus (P < .001), peripheral rim instability (P = .005), and longitudinal tears (P = .015) and require a meniscal repair (P < .001). Patients ≥14 years of age were more likely to have a radial/oblique tear (P = .015) and require additional debridement beyond the physiologic rim (P = .003). Overall, 70% of patients <14 years of age were found to have a complete discoid meniscus necessitating saucerization, and >50% in this young age group required peripheral stabilization/repair. CONCLUSION To preserve physiological "normal" meniscus, a repair may be indicated in >50% of patients <14 years of age but occurred in <50% of those >14 years. Additional resection beyond the physiological rim may be needed in 15% of younger patients and 30% of those aged >14 years.
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Affiliation(s)
| | | | - Jay Albright
- Department of Orthopedics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Sheila Algan
- Department of Orthopedic Surgery, Oklahoma Children's Hospital, Oklahoma City, Oklahoma, USA
| | | | - Richard E. Bowen
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA; Orthopedic Institute for Children's Center for Sports Medicine, Los Angeles, California, USA
| | - Jennifer Brey
- Department of Orthopedics, Norton Children's Orthopedics of Louisville, Louisville, Kentucky, USA
| | - J. Marc Cardelia
- Department of Orthopedics and Sports Medicine, Children's Hospital of the King's Daughters, Norfolk, Virginia, USA
| | - Christian Clark
- OrthoCarolina Pediatric Orthopaedic Center, Charlotte, North Carolina, USA)
| | | | - Allison Crepeau
- Elite Sports Medicine at Connecticut Children's, Hartford, Connecticut, USA; Division of Sports Medicine, Department of Orthopedics, UConn Health, Farmington, Connecticut, USA
| | - Eric Edmonds
- Division of Orthopaedic Surgery, Rady Children's Hospital, San Diego, California, USA
| | - Matthew Ellington
- Department of Orthopedics, Central Texas Pediatric Orthopedics, Austin, Texas, USA; Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Henry B. Ellis
- Investigation performed at Scottish Rite for Children, University of Texas Southwestern Medical Center, Dallas, USA
| | - Peter D. Fabricant
- Division of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA; Weill Cornell Medical College, New York, New York
| | - Jeremy S. Frank
- Division of Pediatric Orthopaedics and Spinal Deformities, Joe DiMaggio Children's Hospital, Hollywood, Florida, USA
| | - Theodore J. Ganley
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Daniel W. Green
- Division of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Andrew Gupta
- Division of Pediatric Orthopaedics and Spinal Deformities, Joe DiMaggio Children's Hospital, Hollywood, Florida, USA
| | - Benton Heyworth
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - W. Craig Kemper
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kevin Latz
- Department of Orthopedics-Sports Medicine, Children's Mercy, Kansas City, Missouri, USA
| | - Alfred Mansour
- Department of Orthopedic Surgery, UTHealth Houston, McGovern Medical School, Houston, Texas, USA
| | - Stephanie Mayer
- Department of Orthopedics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Scott D. McKay
- Baylor College of Medicine, Houston, Texas, USA; Texas Children's Hospital, Houston, Texas, USA
| | - Matthew D. Milewski
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Emily Niu
- Department of Orthopedic Surgery and Sports Medicine, Children's National Medical Center, Washington, DC, USA
| | - Donna M. Pacicca
- Department of Orthopedics-Sports Medicine, Children's Mercy, Kansas City, Missouri, USA
| | - Shital N. Parikh
- Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lauren Pupa
- Baylor College of Medicine, Houston, Texas, USA
| | - Jason Rhodes
- Department of Orthopedics, Children's Hospital Colorado, Aurora, Colorado, USA
| | | | - Gregory A. Schmale
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Matthew Schmitz
- San Antonio Military Medical Center, San Antonio, Texas, USA
| | - Kevin Shea
- Department of Orthopaedics, Stanford University School of Medicine, Stanford, California, USA
| | - Rachel S. Silverstein
- Baylor College of Medicine, Houston, Texas, USA; Texas Children's Hospital, Houston, Texas, USA
| | - Stephen Storer
- Division of Pediatric Orthopaedics and Spinal Deformities, Joe DiMaggio Children's Hospital, Hollywood, Florida, USA
| | - Philip L. Wilson
- University of Texas Southwestern Medical Center, Dallas, Texas, USA; Scottish Rite for Children, Dallas, Texas, USA)
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Schlesinger RP, Rangwani SM, Patel NM. Plain Radiographs Have Limited Utility in the Evaluation of Discoid Lateral Meniscus. JOURNAL OF THE PEDIATRIC ORTHOPAEDIC SOCIETY OF NORTH AMERICA 2023; 5:756. [PMID: 40432949 PMCID: PMC12088137 DOI: 10.55275/jposna-2023-756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Indexed: 05/29/2025]
Abstract
Background: Debate persists regarding the utility of plain film radiography in the diagnosis of discoid lateral meniscus, especially in children. The purpose of this study was to assess various radiographic measurements between healthy children and those with discoid lateral meniscus while controlling for other patient characteristics. Methods: Plain radiographs of 55 pediatric patients with discoid lateral meniscus were matched by age and sex to 55 controls with healthy knees as verified by magnetic resonance imaging. Each radiograph was evaluated for the following parameters: lateral joint space height (both in the central and medial portions of the compartment), medial joint space height, fibular head height, lateral tibial spine height, femoral inter-epicondylar distance, lateral tibial plateau obliquity, and chordal distance of the femoral condyle (medial and lateral). Results: In univariate analysis, children with discoid lateral meniscus had higher median lateral joint space heights (p<0.001) and lower fibular head height (p=0.001) than controls. No other radiographic measurements were significantly different. When adjusting for covariates in regression analysis, the presence of discoid lateral meniscus was predictive of higher lateral joint space heights and lower fibular head height, however, age was also significantly predictive in these models. Conclusions: On plain radiographs, lateral joint space heights and fibular head height are associated with discoid lateral meniscus. However, many previously reported measurements were not predictive. The practical utility of these parameters may be complicated by the impact of age. Advanced imaging is recommended to confirm the diagnosis of discoid lateral meniscus. Level of Evidence: III Key Concepts•Plain films may be used to rule out bony pathology but provide little benefit in ruling in a diagnosis of discoid lateral meniscus.•Many radiographic findings that were previously associated with discoid lateral meniscus are either inapplicable to skeletally immature X-rays or are confounded by age.
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You M, Li P, Zhou K, Chen G, Li J. Comparison between conservative and prophylactically concurrent meniscoplasty on the asymptomatic knee in children with bilateral DLM. Medicine (Baltimore) 2023; 102:e34226. [PMID: 37390247 PMCID: PMC10313277 DOI: 10.1097/md.0000000000034226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/15/2023] [Indexed: 07/02/2023] Open
Abstract
This retrospective study aimed to compare the effectiveness between concurrent meniscoplasty and conservative management on the asymptomatic side in children with unilaterally symptomatic bilateral discoid lateral meniscus operated on the symptomatic side in a tertiary level of clinical care. Patients aged under 14 with unilaterally symptomatic bilateral discoid lateral meniscus underwent arthroscopic meniscoplasty were eligible. Patients were either underwent meniscoplasty on the symptomatic side, with the asymptomatic side conservatively treated (group 1) or underwent meniscoplasty on both sides concurrently (group 2). Functional outcomes were evaluated using the Lysholm score and Ikeuchi score. Relative cost collected through the hospital data was applied by the Kruskal-Wallis test. The occurrence of symptoms was applied by the Kaplan-Meier model. A total of 50 patients (39 female and 11 male) were eligible. For the average Lysholm scores, groups 1 and 2 of the previously asymptomatic side were 90.86 ± 8.25 and 92.62 ± 8.68. For the symptomatic side, the Lysholm scores were 91.38 ± 8.90 and 95.71 ± 7.45. For the average cost of treatment, a significant difference was discovered between group 1 and 2 (P < .0001). The Kaplan-Meier survival analysis of the occurrence of symptoms showed no statistical difference between the 2 groups (P = .162), and the terminal survival rates in the 2 groups were 86.2% and 81.0%, respectively. Conservative treatment reached the same clinical outcomes as the concurrent meniscectomy, with a potential of longer mean survival time and lower demand of cost in treatment.
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Affiliation(s)
- Mingke You
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu City, China
| | - Pengcheng Li
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu City, China
| | - Kai Zhou
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu City, China
| | - Gang Chen
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu City, China
| | - Jian Li
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu City, China
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Yang S, Zhang M, Wang L, You M, Li J, Chen G. Feasibility and efficacy of ultrasound in the diagnosis of discoid lateral meniscus and its classification in children: protocol for a prospective, multicentre, diagnostic test study. BMJ Open 2023; 13:e069527. [PMID: 37164464 PMCID: PMC10174036 DOI: 10.1136/bmjopen-2022-069527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
INTRODUCTION Although ultrasound can reportedly diagnose discoid lateral meniscus (DLM) in children, its widespread application is challenging because the diagnostic criteria are based on qualitative descriptions of DLM morphology rather than quantitative parameters. Additionally, no studies have applied ultrasound in classifying DLM. Therefore, this study aims to establish the quantitative ultrasound parameters that reflect DLM morphology, evaluate the feasibility and validity of these parameters for identifying DLM and their classification, and develop the quantitative ultrasound diagnostic criteria for DLM and their classification in children. METHODS AND ANALYSIS Patients will be recruited from the outpatient clinics of the orthopaedics department at West China Hospital, Sichuan University, the Fourth Medical Center of the Chinese People's Liberation Army General Hospital, Xinhua Hospital affiliated with Shanghai Jiao Tong University School of Medicine, Yibin Hospital affiliated with West China Hospital Sichuan University, Suining Central Hospital and the Third Hospital of Mianyang from August 2022 to July 2024. Eligible patients are those aged ≤14 years, with knee symptoms such as pain, locking and limited extension, and who planned to undergo arthroscopic surgery. Exclusion criteria are patients with contraindications to ultrasound examination, such as severe skin damage or fracture around the knee. The sample size is estimated to be 576 cases with a power of 0.9 for hypothesis testing, a two-sided α of 0.05, and an expected sensitivity and specificity of 95%. Three days before surgery, ultrasound will be used to observe the morphology of the lateral meniscus and measure its width, angle α formed by the chord of upper and lower arc-shaped articular surface at the free edge, and the movement distance of the peripheral rim. Participants will be categorised according to the arthroscopy results for the DLM and its classification. The diagnostic performance of each parameter will be assessed and compared in terms of the area under the curve, sensitivity, specificity, and positive and negative predictive values. ETHICS AND DISSEMINATION This study was approved by the Ethics Committee of West China Hospital, Sichuan University (approval no. 2022-923), and this approval covers all study hospitals. Written informed consent is required from all participants before enrolment in the study. The study's findings will be disseminated through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Registry (ChiCTR2200062000).
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Affiliation(s)
- ShunJie Yang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - MingZhi Zhang
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - LingCheng Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Mingke You
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Jian Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Gang Chen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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Kato T, Kaneda K, Harato K, Otani T, Morioka H. Bilateral Medial and Lateral Discoid Menisci: A Case Report. J Orthop Case Rep 2023; 13:54-58. [PMID: 37187820 PMCID: PMC10178811 DOI: 10.13107/jocr.2023.v13.i03.3582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 01/30/2023] [Indexed: 05/17/2023] Open
Abstract
Introduction A discoid meniscus is a typical anatomical variation of the knee. There are several cases of either lateral or medial discoid menisci; however, their combination is rare. We describe a rare instance of bilateral discoid medial and lateral menisci. Case Report A 14-year-old boy who developed left knee pain after twisting his knee at school was referred to our hospital. He had limited extension of -10°, lateral clicking, and pain on the McMurray test in the left knee and complained of slight clicks in the right knee. Magnetic resonance imaging results for both knees revealed discoid medial and lateral menisci. Surgery was performed on the symptomatic left knee. Arthroscopically, a Wrisberg-type discoid lateral meniscus and an incomplete-type medial discoid meniscus were confirmed. The symptomatic lateral meniscus was saucerized and sutured and only the asymptomatic medial meniscus was observed. The patient was doing well 24 months after surgery. Conclusion We report a rare case of bilateral medial and lateral discoid menisci.
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Affiliation(s)
- Taisei Kato
- Department of Orthopedic Surgery, National Hospital Organization Tokyo Medical Center, Meguro, Tokyo, Japan
| | - Kazuya Kaneda
- Department of Orthopedic Surgery, National Hospital Organization Tokyo Medical Center, Meguro, Tokyo, Japan
| | - Kengo Harato
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Toshiro Otani
- Department of Orthopedic Surgery, International University of Health and Welfare Ichikawa Hospital, Ichikawa, Chiba, Japan
| | - Hideo Morioka
- Department of Orthopedic Surgery, National Hospital Organization Tokyo Medical Center, Meguro, Tokyo, Japan
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20
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Su L, Bennett A, Combs K, Torrez TW, Pham DC, Jackson NJ, Bowen RE, Beck JJ. Arthroscopic Treatment of Symptomatic Discoid Lateral Meniscus and Nondiscoid Meniscus in Adolescent Patients. Am J Sports Med 2022; 50:3805-3811. [PMID: 36342468 DOI: 10.1177/03635465221130455] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Discoid lateral meniscus (DLM) is a rare condition. Patient-reported outcomes using validated instruments are underreported in the literature. DLM outcomes have not been directly compared with nondiscoid meniscus (non-DLM) in adolescent patients. PURPOSE/HYPOTHESIS This study sought to analyze the difference in patient characteristics, surgical treatment, and patient-reported outcomes for adolescent patients arthroscopically treated for symptomatic DLM and non-DLM pathology. We hypothesized that DLM and non-DLM patient-reported outcomes would be similar. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective review of patients aged <18 years with symptomatic DLM and non-DLM pathology was completed between 2015 and 2021 at a single academic institution. Chart reviews for patient characteristics and surgical operative indications and technique were completed. Patient-reported outcome scores were prospectively collected preoperatively and at 6 months, 1 year, and 2 years after surgery. RESULTS Patients in the DLM group (n = 48), when compared with the non-DLM group (n = 45), were younger (12.71 vs 15.78 years, respectively; P < .001) and had lower body mass index (24.53 vs 28.91, respectively; P < .02). Both groups were majority Hispanic and more commonly male (DLM 65% vs non-DLM 60%). All of the DLM patients had surgery on the lateral discoid meniscus (n = 48), whereas the non-DLM group had surgery on the lateral meniscus (n = 37), medial meniscus (n = 7), or both (n = 1). A majority of patients in both groups underwent meniscal repair (DLM 73% and non-DLM 62%), and there was no difference in surgical treatment between groups (P > .05). A statistically significant improvement was seen in International Knee Documentation Committee (IKDC) and Physical Activity Questionnaire (PAQ) scores from the preoperative assessment to 6 months, 1 year, and 2 years after surgery for both DLM and non-DLM groups (P < .05). No difference was found in scores between DLM and non-DLM groups, between sexes, or between age groups (<13 years or ≥13 years) (P > .05). CONCLUSION Although patients with DLM were younger and had lower body mass index, the IKDC and PAQ scores were not significantly different between the DLM and non-DLM groups. Both groups showed a significant improvement in scores relative to their preoperative scores. Sex and age did not affect IKDC or PAQ scores.
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Affiliation(s)
- Lisa Su
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Abbie Bennett
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,Orthopedic Institute for Children, Los Angeles, California, USA
| | - Kristen Combs
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Timothy W Torrez
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Derek C Pham
- Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Nicholas J Jackson
- Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Richard E Bowen
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,Orthopedic Institute for Children, Los Angeles, California, USA
| | - Jennifer J Beck
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,Orthopedic Institute for Children, Los Angeles, California, USA
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21
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Influence of posterior tibial slope on sagittal knee alignment with comparing contralateral knees of anterior cruciate ligament injured patients to healthy knees. Sci Rep 2022; 12:14071. [PMID: 35982105 PMCID: PMC9388669 DOI: 10.1038/s41598-022-18442-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 08/11/2022] [Indexed: 11/16/2022] Open
Abstract
Posterior tibial slope (PTS) has been known to contribute to anterior–posterior knee stability and play an essential biomechanical role in knee kinematics. This study aimed to investigate the effect of PTS on single-leg standing sagittal knee alignment of the intact knee. This study included 100 patients with unilateral ACL injury knee (ACL injury group, 53 patients) or with the normal knee (control group, 47 patients). The single-leg standing sagittal alignment of the unaffected knees of the ACL injury group and normal knees of the control group were assessed radiographically with the following parameters: knee extension angle (EXT), PTS, PTS to the horizontal line (PTS-H), femoral shaft anterior tilt to the vertical axis (FAT), and tibial shaft anterior tilt to the vertical axis (TAT). PTS was negatively correlated with EXT and positively correlated with TAT. EXT was significantly larger in the ACL injury group, whereas TAT was smaller in the ACL injury group. Patients with larger PTS tend to stand with a higher knee flexion angle by tilting the tibia anteriorly, possibly reducing tibial shear force. Patients with ACL injury tend to stand with larger EXT, i.e., there is less preventive alignment to minimize the tibial shear force.
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22
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Araki S, Tsubosaka M, Muratsu H, Inokuchi T, Maruo H, Miya H, Kuroda R, Matsushita T. Evaluation of morphological characteristics for incomplete discoid medial meniscus with an oversized posterior segment. J Orthop Surg Res 2022; 17:245. [PMID: 35443728 PMCID: PMC9022343 DOI: 10.1186/s13018-022-03132-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 04/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A discoid medial meniscus is rare in comparison with a discoid lateral meniscus. We encountered a new type of incomplete discoid with an oversized posterior segment. Therefore, this study aimed to report cases of medial meniscus with an oversized posterior segment and analyze the morphological characteristics by comparing them to cases with a discoid medial meniscus and normal medial meniscus. METHODS Four patients with an oversized posterior segment medial meniscus (oversize group, mean age: 25.3 ± 12.0 years) and seven patients with a discoid medial meniscus (discoid group, mean age: 34.4 ± 19.6) were identified using magnetic resonance imaging (MRI) and diagnosed by arthroscopic findings in our hospital. Fifty patients without medial meniscal injury were retrospectively selected as the normal group (normal group, mean age: 24.0 ± 11.3 years). The clinical symptoms were examined. The anteroposterior (AP) length of both the anterior and posterior segments, AP length ratio of the posterior segment to the AP length of the medial tibial plateau, and mediolateral (ML) width of the mid-body of the medial meniscus were also evaluated using MRI and compared among the three groups. RESULTS All patients in the oversize group complained of medial knee pain during deep knee flexion. In sagittal MRI, posteriorly deviated indentations were also observed at the medial tibial plateau in all cases in the oversize group. There was a significant difference in the AP length of the posterior segment between the normal and oversize groups (14.3 ± 2.8 vs. 23.6 ± 2.8 mm, P < 0.001), whereas there was no significant difference in the AP length of the anterior segment (9.1 ± 2.1 vs. 9.5 ± 1.9 mm, P = 0.869). The ML width of the mid-body in the normal, oversize, and discoid groups was 9.3 ± 1.8, 19.9 ± 2.6, and 25.8 ± 1.9 mm, respectively (normal vs. oversize group: P < 0.001, oversize vs discoid group: P = 0.01, normal vs. discoid group: P < 0.001). CONCLUSIONS Oversized posterior and normal anterior segments characterize this new type of incomplete discoid medial meniscus as a morphological abnormality.
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Affiliation(s)
- Shotaro Araki
- Department of Orthopaedic Surgery, Steel Memorial Hirohata Hospital, 3-1 Yumesaki-chou Hirohata-ku, Himeji-City, Hyogo, 671-1122, Japan
| | - Masanori Tsubosaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hirotsugu Muratsu
- Department of Orthopaedic Surgery, Steel Memorial Hirohata Hospital, 3-1 Yumesaki-chou Hirohata-ku, Himeji-City, Hyogo, 671-1122, Japan.
| | - Takao Inokuchi
- Department of Orthopaedic Surgery, Steel Memorial Hirohata Hospital, 3-1 Yumesaki-chou Hirohata-ku, Himeji-City, Hyogo, 671-1122, Japan
| | - Hiroaki Maruo
- Department of Orthopaedic Surgery, Steel Memorial Hirohata Hospital, 3-1 Yumesaki-chou Hirohata-ku, Himeji-City, Hyogo, 671-1122, Japan
| | - Hidetoshi Miya
- Department of Orthopaedic Surgery, Steel Memorial Hirohata Hospital, 3-1 Yumesaki-chou Hirohata-ku, Himeji-City, Hyogo, 671-1122, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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23
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Brutico JM, Wright ML, Kamel SI, Zoga AC, Poehling-Monaghan K, Hammoud S. The Relationship Between Discoid Meniscus and Articular Cartilage Thickness: A Quantitative Observational Study With MRI. Orthop J Sports Med 2022; 9:23259671211062258. [PMID: 34988233 PMCID: PMC8721379 DOI: 10.1177/23259671211062258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 08/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Several cadaveric imaging studies have demonstrated that the articular cartilage thickness on the tibial plateau varies depending on coverage by native meniscal tissue. These differences are thought to partially contribute to the rates of cartilage degeneration and development of osteoarthritis after meniscectomy. Because there is greater tibial plateau coverage with meniscal tissue in the setting of a discoid meniscus, these findings may also have implications for the long-term health of the knee after saucerization of a torn discoid meniscus. Purpose: To evaluate the relationship between lateral compartment articular cartilage thickness and the presence or absence of a discoid meniscus. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Included in the study were 25 patients younger than 40 years of age who had undergone a 1.5-T or 3-T knee magnetic resonance imaging (MRI) between 2010 and 2016 at a single institution and had an intact, lateral discoid meniscus. Only patients with an otherwise asymptomatic lateral compartment were included. The authors then identified 35 age-matched controls with a nondiscoid, intact lateral meniscus who underwent knee MRI at the same institution and during the same period. The articular cartilage thicknesses in 6 zones of the lateral femoral condyle (LFC) and lateral tibial plateau (LTP) were measured for each patient by 2 musculoskeletal radiologists, and the mean thicknesses were compared between the study and control groups. Results: The average age at MRI was 22.63 years (range, 8.30-35.90 years) for the discoid group and 20.93 years (range, 8.43-34.99 years) for the nondiscoid group. The nondiscoid group had significantly greater mean articular cartilage thickness in all 6 zones of the LTP (P < .05 for all). When comparing the zones of the LFC, there was no significant difference in the mean thickness in any zone between the 2 groups. Conclusion: Patients with discoid menisci had thinner baseline articular cartilage thickness in the LTP compared with those patients without discoid menisci.
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Affiliation(s)
- Joseph M Brutico
- Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Margaret L Wright
- Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sarah I Kamel
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Adam C Zoga
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | | | - Sommer Hammoud
- Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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24
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Yoo HJ, Ryu KN, Park JS, Jin W, Park SY, Kang HJ, Kim HS, Kwon GH. Preoperative Meniscus: Pitfalls and Traps to Avoid. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:582-596. [PMID: 36238512 PMCID: PMC9514523 DOI: 10.3348/jksr.2021.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 04/13/2021] [Accepted: 07/28/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Hye Jin Yoo
- Department of Radiology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Kyung Nam Ryu
- Department of Radiology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Ji Seon Park
- Department of Radiology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Wook Jin
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - So Young Park
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Hye Jin Kang
- Department of Radiology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Hyun Soo Kim
- Department of Radiology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Gene Hyuk Kwon
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
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25
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Gajjar SM, Solanki KP, Shanmugasundaram S, Kambhampati SBS. Meniscal Extrusion: A Narrative Review. Orthop J Sports Med 2021; 9:23259671211043797. [PMID: 34778470 PMCID: PMC8573502 DOI: 10.1177/23259671211043797] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/08/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Meniscal extrusion, referred to as an external displacement of the meniscus, is a commonly encountered but often overlooked magnetic resonance imaging finding in the knee joint. Meniscal extrusion alters the biomechanical properties of the meniscus, leading to accelerated cartilage degeneration and early osteoarthritic changes. The literature contains discrepancies about meniscal extrusion on topics ranging from definition to diagnosis. This narrative review outlines the pathogenesis, natural history, diagnosis, and treatment of meniscal extrusion. Purpose: To review the current literature on meniscal extrusion, from pathogenesis to treatment, and to provide recommendations for future research. Study Design: Narrative review. Methods: A computer-based search of the PubMed, Ovid Medline, and Cochrane Library databases was used to perform a comprehensive literature review on meniscal extrusion. A total of 81 studies was ultimately included in the review. Results: The literature review highlighted the current ambiguity in definition, difficulty in clinical diagnosis, and low level of awareness of this condition. This review covers all aspects related to meniscal extrusion and identifies many of its lesser known aspects. Conclusion: In the current literature, meniscal extrusion remains a lesser known albeit common condition because of its relatively silent nature along with lack of knowledge among orthopaedic surgeons. Further studies are warranted to provide better understanding and management of this condition.
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Affiliation(s)
- Shreyash M Gajjar
- Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
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26
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Jung EY, Jeong S, Kim SK, Lee SS, Ryu DJ, Wang JH. A Useful MRI Classification for Symptomatic Discoid Lateral Meniscus. Knee Surg Relat Res 2021; 33:31. [PMID: 34503579 PMCID: PMC8428092 DOI: 10.1186/s43019-021-00108-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/06/2021] [Indexed: 11/11/2022] Open
Abstract
Purpose The purpose of this study is to classify the discoid lateral meniscus (DLM) according to the signal and shape in magnetic resonance imaging (MRI), and to provide information not only in diagnosis but also in treatment. Materials and Methods We reviewed 162 cases who diagnosed with DLM by MRI and underwent arthroscopic procedures from April 2010 to March 2018. Three observers reviewed MRI findings of all cases and predicted arthroscopic tear using three MRI criteria (criterion 1,2 and 3). Among three criteria, the criterion that most accurately predicts arthroscopic tear was selected. Using this criterion, the cases of predicted tear were named group 1. In addition, group 1 was divided into three subgroups (group 1a, 1b and 1c) by deformation or displacement on MRI and arthroscopic type of tear and procedures were analyzed according to these subgroups. Results The intra-meniscal signal change itself (criterion 3) on MRI showed the highest agreement with the arthroscopic tear. No meniscal deformation and displacement on MRI (group 1a) showed no specific type of tear and more cases of meniscal saucerization. The meniscal deformation on MRI (group 1b) showed more simple horizontal tears and more cases of meniscal saucerization. The meniscal displacement on MRI (group 1c) showed more peripheral tears and more cases of meniscal repair and subtotal meniscectomy. Comparing arthroscopic type of tear and type of arthroscopic procedure between three subgroups, there were significant differences in three groups (P < .05). Conclusions Intra-meniscal signal change itself on MRI is the most accurate finding to predict arthroscopic tear in symptomatic DLM. In addition, subgroup analysis by deformation or displacement on MRI is helpful to predict the type of arthroscopic tear and procedures.
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Affiliation(s)
- Eui Yub Jung
- Department of Orthopedic Surgery, National Medical Center, Seoul, South Korea
| | - Seongmin Jeong
- Department of Orthopedic Surgery, National Medical Center, Seoul, South Korea
| | - Sun-Kyu Kim
- Department of Orthopedic Surgery, National Medical Center, Seoul, South Korea
| | - Sung-Sahn Lee
- Department of Orthopaedic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Goyang-si, Gyeonggi-do, South Korea
| | - Dong Jin Ryu
- Department of Orthopedic Surgery, Inha University Hospital, Inhan University School of Medicine, Incheon, South Korea
| | - Joon Ho Wang
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro Gangnam-gu, Seoul, 06351, South Korea.
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27
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Organ B, Carrasco M, Roth A, Leggit J. Intermittent Knee Locking in an Adolescent Female: A Case Report. Curr Sports Med Rep 2021; 20:447-449. [PMID: 34524187 DOI: 10.1249/jsr.0000000000000876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Brooke Organ
- Saint Louis University, Family Medicine Residency, Southwest, IL
| | - Mia Carrasco
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Alaina Roth
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Jeffrey Leggit
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
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28
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Milewski MD, Coene RP, McFarlane KH, Williams KA, Feldman L, Beck JJ. Nationwide Ethnic/Racial Differences in Surgical Treatment of Discoid Meniscus in Children: A PHIS Database Study. J Pediatr Orthop 2021; 41:490-495. [PMID: 34238865 DOI: 10.1097/bpo.0000000000001894] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Discoid meniscus, a congenital meniscus variant, may have greater incidence in Asian populations. No US population-based studies have examined the discoid meniscus ethnic/racial distribution. In pediatric patients undergoing meniscus surgery, it is hypothesized that ethnic/racial variability exists in patients with discoid meniscus and this variability is different than in patients with medial meniscus tears. METHODS The Pediatric Health Information System was queried from 48 hospitals to examine patients 18 years of age and younger between 2015 and 2019, using International Classification of Diseases, 10th Revision, Clinical Modification codes. A cohort of patients treated surgically for discoid meniscus was compared with a cohort of patients treated surgically for medial meniscal tear. These 2 populations were compared based on age, sex, ethnicity/race, Current Procedural Terminology code, insurance, urban versus rural, and region of country. Univariate testing and multivariable logistic modeling were used to test for associations. RESULTS A discoid meniscus cohort of 399 children (median age, 13.0 y) was compared with a medial meniscus tear cohort of 3157 children (median age, 16.0 y) (P<0.001). Hispanic/Latino children accounted for 36.8% of the discoid lateral meniscus and 22.7% of the medial meniscus populations (P<0.001). Among pediatric patients that had surgery for discoid lateral meniscus or medial meniscus, Hispanic/Latino children had 2.36 times the odds of surgery for discoid meniscus compared with White patients after adjusting for age and insurance (P<0.001). Asian children also had 2.41 times the odds of surgery for discoid meniscus compared with White patients (P=0.017). CONCLUSIONS This study shows a significant association of ethnicity/race with discoid versus medial meniscus surgical treatment in children. Among pediatric patients undergoing surgery for discoid meniscus, Hispanic/Latino and Asian patients were a significantly larger percentage of the population than White patients. Hispanic/Latino children made up a greater percentage of the population having surgery for a torn discoid meniscus versus a torn medial mensicus. When evaluating pediatric patients, younger age and Asian or Hispanic/Latino ethnicity should increase attention to the possibility of a discoid meniscus. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Matthew D Milewski
- Department of Orthopaedic Surgery, Division of Sports Medicine, Boston Children's Hospital
- Harvard Medical School, Boston, MA
| | - Ryan P Coene
- Department of Orthopaedic Surgery, Division of Sports Medicine, Boston Children's Hospital
| | - Kelly H McFarlane
- Department of Orthopaedic Surgery, Division of Sports Medicine, Boston Children's Hospital
- Harvard Medical School, Boston, MA
| | - Kathryn A Williams
- Department of Orthopaedic Surgery, Division of Sports Medicine, Boston Children's Hospital
| | - Lanna Feldman
- Department of Orthopaedic Surgery, Division of Sports Medicine, Boston Children's Hospital
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29
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Hesse DG, Finlayson CJ, Gladstein AZ, Samet JD. Pediatric discoid meniscus: can magnetic resonance imaging features coupled with clinical symptoms predict the need for surgery? Pediatr Radiol 2021; 51:1696-1704. [PMID: 33944960 DOI: 10.1007/s00247-021-05063-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/10/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) criteria for evaluating discoid meniscus is limited in the pediatric population. OBJECTIVE To assess MRI features of intact discoid meniscus and correlate with clinical outcomes. MATERIALS AND METHODS In this institutional review board (IRB)-approved retrospective cohort study, knee MRIs at our institution from 2008 to 2019 were reviewed. The inclusion criterion was diagnosis of discoid meniscus on MRI. Exclusion criteria were torn discoid meniscus at presentation, previous meniscal surgery and confounding knee conditions. MRI features of discoid meniscus collected were craniocaudal dimension, transverse dimension, transverse dimension to tibial plateau (TV:TP) ratio and increased intrameniscal signal. The clinical course was reviewed for knee pain, mechanical symptoms and treatment type. RESULTS Two hundred and nineteen of 3,277 (6.7%) patients had discoid meniscus. Of the 219 patients, 71 (32.4%) satisfied inclusion criteria. Seven patients had discoid meniscus of both knees resulting in 78 discoid menisci. The average patient age was 11.1 years (min: 2.0, max: 17.0). The average follow-up was 30.6 months. Of the 78 discoid menisci, 14 (17.9%) required surgery. Increased intrameniscal signal was found more in discoid meniscus requiring surgery (surgical: 10/14, nonsurgical: 19/64, P=0.009). Surgically treated discoid meniscus had a statistically significant increase in transverse dimension (surgical: 18.3±5.0 mm, nonsurgical: 15.7±4.3 mm, P=0.045) and TV:TP ratio (surgical: 0.55±0.15, nonsurgical: 0.47±0.12, P=0.036). Mechanical symptoms (surgical: 9/11, nonsurgical: 21/60, P=8.4×10-6) and pain ≥1 month (surgical: 11/11, nonsurgical: 17/60, P=0.006) were found more often in surgical patients. Clinical and imaging criteria of mechanical symptoms and knee pain ≥1 month and at least one of (1) increased intrameniscal signal or (2) TV:TP ratio greater than 0.47 identified discoid menisci that developed a tear and/or required surgery with a sensitivity of 0.86 and specificity of 0.88. CONCLUSION Mechanical symptoms and knee pain ≥1 month, and at least one of (1) increased intrameniscal signal or (2) TV:TP ratio greater than or equal to 0.47, identified discoid menisci that would go on to tear and/or require surgery with a sensitivity and specificity of 0.86 and 0.88, respectively.
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Affiliation(s)
- Derek G Hesse
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA.
| | - Craig J Finlayson
- Department of Orthopedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Orthopedic Surgery, Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Aharon Z Gladstein
- Department of Orthopedic Surgery, Texas Children's Hospital, Houston, TX, USA
| | - Jonathan D Samet
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA.,Department of Medical Imaging, Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA
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Intrasubstance degeneration of medial meniscus horizontal cleavage tear in young patients is associated with increased joint line obliquity in the coronal plane of the knee. Knee Surg Sports Traumatol Arthrosc 2021; 29:1797-1804. [PMID: 32803276 DOI: 10.1007/s00167-020-06214-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the effect of joint line obliquity of the knee on intrasubstance degeneration of isolated medial meniscus horizontal cleavage tear (HCT) in young patients. METHODS Sixty knees of 50 patients aged < 40 years (mean age, 33.3 ± 5.5 years old), who underwent arthroscopic partial meniscectomy (APM) for HCT, were retrospectively reviewed. The radiologic parameters of alignment, including mechanical hip-knee-ankle (mHKA) angle, posterior tibial slope, and joint line obliquity, were measured on preoperative long-standing whole-leg radiographs. The patients were classified into two groups, simple horizontal type (type 1) and complicated type (type 2), according to the presence of diffuse intrasubstance degeneration of the meniscus on preoperative magnetic resonance imaging. The risk factors for intrasubstance degeneration of HCT were analyzed using multiple logistic regression analysis. Medial joint space width (JSW) on weight-bearing 45° flexion posteroanterior radiographs and the mHKA were measured to evaluate the radiographic outcomes. The clinical outcomes were evaluated using the modified Lysholm score. Among patients followed-up for > 5 years, the clinical and radiologic outcomes were compared between the two groups. RESULTS The joint line obliquity was significantly greater in the type 2 group than in the type 1 group (2.9 ± 1.3 vs. 0.9 ± 1.4, P < 0.001), and a significant risk factor for diffuse intrasubstance degeneration (P < 0.001; odds ratio, 2.88; 95% confidence interval, 1.27-6.54). The relative changes in the JSW in the type 2 group were greater than those in the type 1 group during the mean follow-up period of 7.9 ± 2.5 years (26% vs 10%, P = 0.045). The modified Lysholm score was not significantly different between the two groups (n.s). CONCLUSION The diffuse intrasubstance degeneration of medial meniscus HCTs in young patients is associated with increased joint line obliquity of the knee joints. The radiologic outcomes after APM were inferior in the patients with diffuse intrasubstance degeneration. However, the clinical outcomes were not different during the mid-term follow-up. LEVEL OF EVIDENCE Level III.
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Turati M, Anghilieri FM, Accadbled F, Piatti M, Di Benedetto P, Moltrasio F, Zatti G, Zanchi N, Bigoni M. Discoid meniscus in human fetuses: A systematic review. Knee 2021; 30:205-213. [PMID: 33945980 DOI: 10.1016/j.knee.2021.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/02/2020] [Accepted: 04/09/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Discoid meniscus (DM) is a rare variant of regular knee anatomy. Compared to standard meniscus it is thicker and abnormal in shape; these characteristics make it more prone to tear. It is a congenital defect whose correct etiology is still debated and far from being clarified. The purpose of this systematic review is to evaluate evidences of DM in human fetuses in order to assess whether embryological development may have a role. METHODS A systematic review was performed on PubMed, Scopus, and Embase with different combinations of the keywords "discoid meniscus", "embryology", "fetus", "neonatal". Search yielded 1013 studies, on which we performed a primary evaluation. RESULTS Seven studies were considered including a total of 1378 fetal menisci specimens, from 396 different fetuses. Discoid shape was not found represented as a normal stage of prenatal development. From 782 lateral menisci analyzed, only 86 (10.86%) were discoid (13 complete, 73 incomplete type). None of medial menisci was found to be discoid. Lateral meniscus was observed to cover a larger surface of tibial plateau than medial one until 28th gestational week. CONCLUSION Lateral meniscus seems to be more prone to discoid shape for its natural tendency of covering a larger surface of the tibial plateau during fetal stages. However the fact that a discoid shape was not found in the majority of fetuses suggests that it is not a normal stage of fetal development. To support a single etiological factor it will be appropriate to have further morphological and morphometric studies.
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Affiliation(s)
- Marco Turati
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy; Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Department of Paediatric Orthopaedic Surgery, Hospital Couple Enfant, Grenoble Alpes University, Grenoble, France.
| | | | - Franck Accadbled
- Department of Orthopedics, Children's Hospital, Toulouse University Hospital, France
| | - Massimiliano Piatti
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy; Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France
| | - Paolo Di Benedetto
- Medical Departement (DAME) - University of Udine, Italy; Clinic of Orthopaedics, Friuli Centrale Healthcare and University Trust (ASUFC), Udine, Italy
| | | | - Giovanni Zatti
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Nicolò Zanchi
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Marco Bigoni
- Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy; Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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Kuwabara A, Kraus E, Fredericson M. Narrative Review - Knee Pain in the Pediatric Athlete. Curr Rev Musculoskelet Med 2021; 14:239-245. [PMID: 33818701 PMCID: PMC8137791 DOI: 10.1007/s12178-021-09708-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW This review article seeks to highlight common youth athlete knee conditions due to overuse or trauma and elucidate differences from the adult populations. RECENT FINDINGS Overuse conditions presented include apophysitis, osteochondritis dissecans plica syndrome, and discoid meniscus. Traumatic conditions presented include patellar instability, patellar sleeve fracture, and patellofemoral osteochondral fractures. Knee injuries affect a significant proportion of youth athletes. These injuries place athletes at higher risk of chronic pain and potentially osteoarthritis. We have reviewed common overuse and traumatic knee injuries and differentiating factors between the adult population to improve and expedite the diagnosis, treatment, and prognosis for youth athletes with knee injuries.
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Affiliation(s)
- Anne Kuwabara
- Department of Physical Medicine and Rehabilitation, Stanford University, 500 Jefferson Avenue #823, Redwood City, CA 94063 USA
| | - Emily Kraus
- Department of Physical Medicine and Rehabilitation, Stanford University, 500 Jefferson Avenue #823, Redwood City, CA 94063 USA
| | - Michael Fredericson
- Department of Physical Medicine and Rehabilitation, Stanford University, 500 Jefferson Avenue #823, Redwood City, CA 94063 USA
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Kita T, Tajima T, Chosa E. Turner's syndrome associated with discoid lateral meniscus and Blount's disease: a case report. BMC Musculoskelet Disord 2021; 22:449. [PMID: 33992118 PMCID: PMC8126072 DOI: 10.1186/s12891-021-04336-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/06/2021] [Indexed: 11/21/2022] Open
Abstract
Background Turner’s syndrome, discoid meniscus, and Blount’s disease have all been studied in isolation, but, to the best of our knowledge, there have been no studies reporting a patient with all three. Thus, the first case of Turner’s syndrome with discoid meniscus and Blount’s disease is presented. Case presentation A 5-year-old Japanese girl with a history of Turner’s syndrome and Blount’s disease complained of pain in her left knee. Magnetic resonance imaging showed a discoid lateral meniscus tear, and arthroscopic partial meniscectomy was performed, providing a good outcome. Conclusions In this report, some possible explanations regarding the concomitant presence of these three diseases are discussed. A possible explanation in this case is that the patient with Turner’s syndrome had a discoid lateral meniscus that might have been induced by some genetic factors associated with Turner’s syndrome, and then the discoid lateral meniscus might have been the mechanical stress that caused Blount’s disease.
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Affiliation(s)
- Tsunemasa Kita
- Department of Orthopedic Surgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Takuya Tajima
- Department of Orthopedic Surgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan.
| | - Etsuo Chosa
- Department of Orthopedic Surgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
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Sweeney E, Rodenberg R, MacDonald J. Overuse Knee Pain in the Pediatric and Adolescent Athlete. Curr Sports Med Rep 2021; 19:479-485. [PMID: 33156034 DOI: 10.1249/jsr.0000000000000773] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Overuse knee pain is common in young athletes. There are many potential overuse injuries which present with insidious onset of pain that can challenge sports medicine providers, including Osgood-Schlatter's disease, patellofemoral syndrome, osteochondritis dissecans, and stress fractures. The differential diagnosis of insidious onset knee pain also includes malignancies, infections, and rheumatologic issues. A thorough history and physical examination can guide the treating provider in making a diagnosis and appropriate treatment plan. Although not always necessary, imaging is often helpful in overuse knee pain, and laboratory workup may be necessary. Conservative treatment is often the first recommendation in the management of overuse knee pain in young athletes, and this may include activity modification, ice, anti-inflammatory medications, bracing, and physical therapy. This review summarizes common overuse knee injuries seen in pediatric and adolescent athletes.
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Suzuki T, Matsumura T, Otsubo H, Kuroda M. Meniscus Repair With Anterior Cord Release for Peripheral Tear Type of Discoid Lateral Meniscus. Arthrosc Tech 2021; 10:e353-e357. [PMID: 33680766 PMCID: PMC7917086 DOI: 10.1016/j.eats.2020.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 10/09/2020] [Indexed: 02/03/2023] Open
Abstract
With improvement in arthroscopic techniques, partial meniscectomy with repair for symptomatic discoid lateral meniscus (DLM) has been the preferred treatment to restore meniscal function. It was reported that DLM exhibited deformation and extrusion shortly after saucerization with repair. Therefore it is desirable to minimize removal of the DLM. The anterior zone of the DLM is often tighter than that of the normal meniscus and anatomic variant. It is considered that the anterior and anterocentral dislocation types in the majority of symptomatic DLM can be related to both peripheral instability and anterior tightness. We present a technique that, first, the inside-out repair technique is applied from the posterior to middle segment of the DLM; next, the tension of the anterior zone during knee flexion-extension is confirmed to determine the released amount of that part; and, finally, all sutures are tied to reproduce the normal meniscus movement. Meniscus repair with anterior cord release without any meniscectomy could resolve peripheral instability of DLM and prevent degeneration of the articular cartilage.
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Affiliation(s)
- Tomoyuki Suzuki
- Department of Orthopaedic Surgery, Sapporo Maruyama Orthopaedic Hospital, Chuo-ku, Sapporo, Hokkaido, Japan,Address correspondence to Tomoyuki Suzuki, M.D., Ph.D. Department of Orthopaedic Surgery, Sapporo Maruyama Orthopaedic Hospital, N7-W27, 1-3, Chuo-ku, Sapporo, Hokkaido 060-0007, Japan.
| | - Takashi Matsumura
- Department of Orthopaedic Surgery, Obihiro Kyokai Hospital, Chuo-ku, Sapporo, Hokkaido, Japan
| | - Hidenori Otsubo
- Department of Orthopaedic Surgery, Sapporo Sports Clinic, Chuo-ku, Sapporo, Hokkaido, Japan
| | - Miki Kuroda
- Department of Orthopaedic Surgery, Sapporo Maruyama Orthopaedic Hospital, Chuo-ku, Sapporo, Hokkaido, Japan
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A predictive model with radiographic signs can be a useful supplementary diagnostic tool for complete discoid lateral meniscus in adults. Knee Surg Sports Traumatol Arthrosc 2021; 29:474-482. [PMID: 32246171 DOI: 10.1007/s00167-020-05972-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 03/25/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To investigate the diagnostic accuracy of radiographic signs for complete discoid lateral meniscus and whether a predictive model combining the radiographic signs can improve its diagnostic accuracy in adults. METHODS A total of adult 119 knees with complete discoid lateral meniscus confirmed by arthroscopy and 119 age- and sex-matched knees with normal meniscus were included. The radiographic signs of lateral joint space, fibular head height, lateral tibial spine height, lateral tibial plateau obliquity, lateral femoral condyle squaring, lateral tibial plateau cupping, lateral femoral condyle notching, and the condylar cut-off sign were evaluated. The receiver-operating characteristic (ROC) curves and area under the curve (AUC) were evaluated for best accuracy. A prediction model was developed by multivariable regression with generalized estimating models, and was validated using data from 111 knees of children with complete discoid lateral meniscus and 111 normal controls. RESULTS The fibular head height, lateral joint space, lateral tibial plateau obliquity, and the condylar cut-off sign were significantly different between the complete discoid lateral meniscus and the normal groups (p < 0.05). Among the four radiographic signs, the fibular head height showed the highest accuracy with 78.9% sensitivity and 57.3% specificity. The prediction models developed by logistic regression showed significantly improved accuracy for complete discoid lateral meniscus compared to the fibular head height (sensitivity: 69.8%, specificity: 82.9%, p = 0.001). For validation, the AUC of children seemed to be larger than that of adults, which indicated that the prediction models could be applied for children to detect complete discoid lateral meniscus. CONCLUSION Among several radiographic signs, the fibular head height can be used as a screening tool for complete discoid lateral meniscus. The prediction models combined with lateral joint space, fibular head height, lateral tibial plateau obliquity, and/or the condylar cut-off sign yielded a much higher diagnostic value than each radiographic sign. Therefore, fibular head height and prediction models combined with radiographic signs can provide improved diagnostic value for complete discoid lateral meniscus. LEVEL OF EVIDENCE III.
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Zaffagnini S, Espinosa M, Neri MP, Marcacci M, Grassi A. Treatment of Meniscal Deficiency with Meniscal Allograft Transplantation and Femoral Osteotomy in a Patient with History of Lateral Discoid Meniscus: 15-Year Follow-up Case Report. JBJS Case Connect 2021; 10:e0079. [PMID: 32044789 DOI: 10.2106/jbjs.cc.19.00079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 15-year-old woman with multiple arthroscopic procedures for left lateral discoid meniscus since the age of 9 presented with pain, swelling, and mechanical symptoms. A meniscal allograft transplantation (MAT) and lateral opening-wedge femoral osteotomy was performed. At the 6-year follow-up, the patient presented a visual analog scale (VAS) score of 0, subjective International Knee Documentation Committee (IKDC) of 88, and Lysholm of 95. At 15-year follow-up, the VAS score was 0, subjective IKDC 85.1, and Lysholm 86. CONCLUSIONS MAT associated with femoral osteotomy was an effective procedure in this patient with pain and functional limitation after total meniscectomy in the setting of discoid meniscus and valgus malalignment. Good clinical and magnetic resonance imaging-related outcomes were achieved at the intermediate and long-term follow-up.
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Affiliation(s)
- Stefano Zaffagnini
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Università di Bologna, Bologna, Italy
| | - Maximiliano Espinosa
- Departamento de Traumatología, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Maria Pia Neri
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Alberto Grassi
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Università di Bologna, Bologna, Italy
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Kim JH, Ahn JH, Kim JH, Wang JH. Discoid lateral meniscus: importance, diagnosis, and treatment. J Exp Orthop 2020; 7:81. [PMID: 33044686 PMCID: PMC7550551 DOI: 10.1186/s40634-020-00294-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/22/2020] [Indexed: 11/10/2022] Open
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.
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Affiliation(s)
- Jun-Ho Kim
- Department of Orthopedic Surgery, Seoul Medical Center, 156 Sinnae-ro, Jungnang-gu, Seoul, South Korea
| | - Jin Hwan Ahn
- Department of Orthopedic Surgery, Saeum Hospital, Seoul, South Korea
| | - Joo-Hwan Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, gangnam-gu, Seoul, 135-710, South Korea
| | - Joon Ho Wang
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, gangnam-gu, Seoul, 135-710, South Korea. .,Department of Health Sciences and Technology and Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, South Korea.
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Abstract
Discoid meniscus is the most frequent congenital malformation of the menisci, and primarily affects the lateral meniscus; it is highly prevalent in the Asian population.The anatomic, vascular, and ultrastructural features of the discoid meniscus make it susceptible to complex tears.Discoid meniscus anomalies are described according to their shape; however, there is consensus that peripheral stability of the meniscus should also be defined.Initial workup includes plain X-rays and magnetic resonance imaging, while arthroscopic evaluation confirms shape and stability of the meniscus.Clinical presentation is highly variable, depending on shape, associated hypermobility, and concomitant meniscal tears.Treatment seeks to re-establish typical anatomy using saucerization, tear reparation, and stable fixation of the meniscus. Cite this article: EFORT Open Rev 2020;5:371-379. DOI: 10.1302/2058-5241.5.190023.
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Affiliation(s)
| | - Matías Sepúlveda
- Universidad Austral de Chile, Valdivia, Chile
- AO Foundation, PAEG Expert Group, Davos, Switzerland
- Hospital Base de Valdivia, Valdivia, Chile
| | - María Jesús Tuca
- Clinica Alemana, Santiago, Chile
- Universidad del Desarrollo, Santiago, Chile
- Hospital Clínico Mutual de Seguridad, Santiago, Chile
| | - Estefanía Birrer
- Universidad Austral de Chile, Valdivia, Chile
- AO Foundation, PAEG Expert Group, Davos, Switzerland
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Ha CW, Kim SH, Lee DH, Kim H, Park YB. Predictive validity of radiographic signs of complete discoid lateral meniscus in children using machine learning techniques. J Orthop Res 2020; 38:1279-1288. [PMID: 31883134 DOI: 10.1002/jor.24578] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 12/04/2019] [Indexed: 02/04/2023]
Abstract
The diagnostic utility of radiographic signs of complete discoid lateral meniscus remains controversial. This study aimed to investigate the diagnostic accuracy and determine which sign is most reliably detects the presence of a complete discoid lateral meniscus in children. A total of 141 knees (age 7-16) with complete discoid lateral meniscus and 141 age- and sex-matched knees with normal meniscus were included. The following radiographic signs were evaluated: lateral joint (LJ) space, fibular head (FH) height, lateral tibial spine (LTS) height, lateral tibial plateau (LTP) obliquity, lateral femoral condyle (LFC) squaring, LTP cupping, LFC notching, and prominence ratio of the femoral condyle. Prediction models were constructed using logistic regressions, decision trees, and random forest analyses. Receiver operating characteristic curves and area under the curve (AUC) were estimated to compare the diagnostic accuracy of the radiographic signs and model fit. The random forest model yielded the best diagnostic accuracy (AUC: 0.909), with 86.5% sensitivity and 82.2% specificity. LJ space height, FH height, and prominence ratio showed statistically large AUC compared with LTS height and LTP obliquity (P < .05 in all). The cut-off values for diagnosing discoid meniscus to be <12.55 mm for FH height, <0.804 for prominence ratio, and >6.6 mm for LJ space height when using the random forest model. On the basis of the results of this study, in clinical practice, LJ space height, FH height and prominence ratio could be easily used as supplementary tools for complete discoid lateral meniscus in children.
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Affiliation(s)
- Chul-Won Ha
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seong Hwan Kim
- Department of Orthopedic Surgery, Hyundae General Hospital, Chung-Ang University College of Medicine, Namyangju-si, Gyeonggi-do, South Korea
| | - Dong-Hoon Lee
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Hyojoon Kim
- Department of Computer Science, Princeton University, Princeton, New Jersey
| | - Yong-Beom Park
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
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Factors associated with bilateral discoid lateral meniscus tear in patients with symptomatic discoid lateral meniscus tear using MRI and X-ray. Orthop Traumatol Surg Res 2019; 105:1389-1394. [PMID: 31607576 DOI: 10.1016/j.otsr.2019.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/23/2019] [Accepted: 08/22/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The incidence of bilateral discoid lateral meniscus (DLM) is as high as 73 to 85%, and associated contralateral meniscus tears ranged from 4 to 33% in symptomatic surgical DLM. The goal of the study was analyzing the factors that predict contralateral presence and tearing of DLM in patients who underwent surgery for symptomatic DLM. Our hypothesis was that there is a significant correlation between operative DLM properties and the incidence of bilateral DLM with associated contralateral meniscus tears. These properties include tear patterns, younger patient age, and characteristic X-ray findings. PATIENTS AND METHODS This prospective study included 76 patients who underwent arthroscopic surgery for symptomatic DLM. The contralateral knees were evaluated with X-ray and MRI. Based on the MRI findings, DLM was categorized into three types, and tear patterns were analyzed. The characteristic X-ray findings were evaluated as follows: (1) high fibular head, (2) squared-off appearance of the lateral femoral condyle, (3) cupping of the lateral tibial plateau, (4) widened femorotibial joint space, (5) hypoplasia of the lateral intercondylar spine, (6) notching of the LFC. The number of characteristic X-ray findings (0/1/more than 2) was noted. Binary logistic analysis was performed to find the factors that predict the presence and tear of contralateral DLM. RESULTS MRI of contralateral knees revealed 43 cases (57%) of complete DLM, 25 cases (33%) of incomplete DLM, and 8 cases (11%) of normal meniscus. Meniscus tears were found in 29 cases (38%) in the contralateral knee. X-ray of the contralateral knee revealed that 27 patients (36%) had one and 24 patients (32%) had two or more characteristic X-ray findings. On logistic regression analysis, the associations between contralateral knee meniscal tear and the presence of one or more than two characteristic X-ray findings were statistically significant (OR: 16.5, p=0.028; OR: 264.0, p=0.000, respectively). DISCUSSION The number of characteristic X-ray findings in the contralateral knee is a significant predictive factor for contralateral DLM type and/or tear. Symptomatic DLM patients with characteristic X-ray findings should be carefully evaluated for contralateral DLM and meniscal tears. LEVEL OF EVIDENCE III, prospective diagnostic study of consecutive patients.
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Cho WJ, Kim JM, Lee BS, Kim HJ, Bin SI. Discoid lateral meniscus: a simple horizontal tear was associated with less articular cartilage degeneration compared to other types of tear. Knee Surg Sports Traumatol Arthrosc 2019; 27:3390-3395. [PMID: 30888447 DOI: 10.1007/s00167-019-05363-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 01/18/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE The relationship between the tear type of discoid lateral meniscus (DLM) and articular cartilage degeneration has not been well studied. METHODS Data from patients with DLM tears who underwent arthroscopic surgery, between 2008 and 2016, were reviewed retrospectively. Demographic variables were obtained from medical records. The types of DLM and meniscal tear and status of cartilage were assessed using operation records and arthroscopic images. Patients were assigned to horizontal or non-horizontal tear groups according to the types of the tear. Factors affecting cartilage degeneration of the lateral femoral condyle (LFC) and lateral tibial plateau (LTP) were identified using logistic regression analysis. The horizontal tear group was divided into two subgroups on the basis of the median value of duration of symptoms and difference in cartilage degeneration between the two subgroups was evaluated. RESULTS Overall, 355 knees were enrolled and assigned to the horizontal (n = 53) or the non-horizontal (n = 302) tear groups. The incidence of International Cartilage Repair Society grades 2-4 cartilage lesions of the LFC (0%, P < 0.001) and LTP (24.5%, P < 0.001) was significantly lower in the horizontal tear group than in the non-horizontal tear group. Horizontal tear [LFC, odds ratio (OR) = 0.02, P < 0.001; LTP, OR = 0.27, P < 0.001] and age (LFC, OR = 1.04, P < 0.001; LTP, OR = 1.03, P < 0.001) were significantly related to cartilage status. There was no difference in cartilage degeneration between the two subgroups in the horizontal tear group. CONCLUSIONS A simple horizontal tear was associated with less articular cartilage degeneration compared to other types of tear in the DLM. In the case of simple horizontal tear, there was no difference in the degree of cartilage degeneration according to the duration of symptoms. Therefore, it is not necessary to perform surgical treatment promptly in cases of simple horizontal tears unless the patient's symptoms are severe. LEVEL OF EVIDENCE III, Case-Control Study.
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Affiliation(s)
| | - Jong-Min Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| | - Bum-Sik Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Hyo-June Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Seong-Il Bin
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
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Zhou Z, Xiao L, He C, Zhang Y, Xue C, Qiao S, Zhang G, Wang Z. Application of assisted portal under anterior horn of lateral meniscus for the treatment of discoid meniscus injury. Knee 2019; 26:1125-1135. [PMID: 31351849 DOI: 10.1016/j.knee.2019.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 05/05/2019] [Accepted: 07/02/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Zhiyou Zhou
- Department of Orthopedics, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Lei Xiao
- The Orthopedics Department, NO.515 Hospital of PLA, Wuxi, China
| | - Chongru He
- Department of Orthopedics, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Yongjin Zhang
- Department of Orthopedics, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Chenchen Xue
- Department of Orthopedics, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Suchi Qiao
- Department of Orthopedics, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Guobin Zhang
- Department of Orthopedics, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Zimin Wang
- Department of Orthopedics, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China.
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Lee DH, D'Lima DD, Lee SH. Clinical and radiographic results of partial versus total meniscectomy in patients with symptomatic discoid lateral meniscus: A systematic review and meta-analysis. Orthop Traumatol Surg Res 2019; 105:669-675. [PMID: 31027980 DOI: 10.1016/j.otsr.2019.02.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/24/2019] [Accepted: 02/14/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Some reports have noted favorable long-term clinical results with milder postoperative arthritic changes after total meniscectomy in symptomatic patients with torn discoid lateral meniscus (DLM). This meta-analysis was conducted to compare the clinical and radiographic results between partial and total meniscectomy in patients with symptomatic DLM. METHODS Studies were included in the meta-analysis if (1) they analysed patients who underwent arthroscopic surgeries for DLMs, (2) they directly compared clinical outcomes in patients treated with partial and total meniscectomies, (3) they analysed at least one parameter related to postoperative outcomes, including the Ikeuchi scale, and/or radiographic results including the Tapper and Hoover classification. RESULTS Eight studies were finally included. The proportion of the knees with excellent or good grade appeared to be higher in partial than in total meniscectomy group, but this difference did not reach statistical significance [128/158 (81.0%) vs. 87/131 (66.4%); OR 1.62; p=0.10; I2=0%]. The pooled results of the proportion of normal cartilage status or mild chondral wear (grade 0 or 1 of the Tapper and Hoover classification) were significantly much higher with partial than with total meniscectomy [228/261 (87.4%) vs. 94/169 (55.6%); OR 9.08; p<0.001; I2=57%]. CONCLUSION This meta-analysis showed that the radiographic outcomes of DLM were better with partial meniscectomy with or without repair than with total meniscectomy, but their clinical outcomes were similar. The findings thus suggest that meniscal preservation would be a better option than total meniscectomy for symptomatic DLM. LEVEL OF EVIDENCE II, Systematic review and Meta-analysis.
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Affiliation(s)
- Dae-Hee Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Darryl D D'Lima
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, United States
| | - Sang Hak Lee
- Department of Orthopaedic Surgery, Center for Joint Diseases and Rheumatism, Kyung Hee, University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, 134-727 Seoul, Republic of Korea.
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Restrepo R, Weisberg MD, Pevsner R, Swirsky S, Lee EY. Discoid Meniscus in the Pediatric Population:. Magn Reson Imaging Clin N Am 2019; 27:323-339. [DOI: 10.1016/j.mric.2019.01.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Suga N, Nakasa T, Ishikawa M, Nakamae A, Hayashi S, Yoshikawa M, Sumida Y, Tsuyuguchi Y, Adachi N. Characteristic morphology of the proximal tibiofibular joint in patients with discoid lateral meniscus. Knee 2018; 25:1027-1032. [PMID: 30108012 DOI: 10.1016/j.knee.2018.07.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/14/2018] [Accepted: 07/31/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patients with discoid lateral meniscus (DLM) are prone to meniscal injuries related to its shape and abnormal mobility. The anatomical joint inclination of the proximal tibiofibular joint (PTFJ) can also affect joint movement in knee motion. However, an association between PTFJ morphology and DLM remains unclear. The purpose of this study was to investigate the morphology of the PTFJ on MRI and how this differs between patients with and without DLM. MATERIALS AND METHODS Fifty-eight patients with DLM and 58 age-matched controls (normal meniscus) were included in this study. Slices from preoperative MRI sagittal images that clearly showed the PTFJ were used for measurements. The angle between the PTFJ and the perpendicular line of the fibula axis was measured as the inclination angle, and patients were classified as horizontal-type (<20°) or oblique-type (>20°). The inclination angle was also compared among patients with open and closed epiphysis in both groups to assess the effect of age. RESULTS Patients in the horizontal-type PTFJ group frequently had DLM. Before epiphyseal closure, most patients had a horizontal-type PTFJ, with or without DLM. However, in older patients with a closed epiphysis, most with a normal meniscus had an oblique-type PTFJ, and those with DLM retained the horizontal-type joint. CONCLUSION The horizontal-type PTFJ was significantly associated with DLM, and patients with DLM tended to retain a horizontal-type PTFJ after epiphyseal closure. In contrast, in patients with a normal meniscus, the PTFJ may change from a horizontal-type to an oblique-type PTFJ in line with bone maturity.
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Affiliation(s)
- Norifumi Suga
- Dept. of Orthop. Surg., University of Hiroshima, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Hiroshima, Japan.
| | - Tomoyuki Nakasa
- Dept. of Orthop. Surg., University of Hiroshima, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Hiroshima, Japan
| | - Masakazu Ishikawa
- Dept. of Orthop. Surg., University of Hiroshima, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Hiroshima, Japan
| | - Atsuo Nakamae
- Dept. of Orthop. Surg., University of Hiroshima, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Hiroshima, Japan
| | - Seiju Hayashi
- Dept. of Orthop. Surg., University of Hiroshima, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Hiroshima, Japan
| | - Masahiro Yoshikawa
- Dept. of Orthop. Surg., University of Hiroshima, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Hiroshima, Japan
| | - Yoshikazu Sumida
- Dept. of Orthop. Surg., University of Hiroshima, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Hiroshima, Japan
| | - Yusuke Tsuyuguchi
- Dept. of Orthop. Surg., University of Hiroshima, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Hiroshima, Japan
| | - Nobuo Adachi
- Dept. of Orthop. Surg., University of Hiroshima, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Hiroshima, Japan
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Gamer LW, Pregizer S, Gamer J, Feigenson M, Ionescu A, Li Q, Han L, Rosen V. The Role of Bmp2 in the Maturation and Maintenance of the Murine Knee Joint. J Bone Miner Res 2018; 33:1708-1717. [PMID: 29665134 DOI: 10.1002/jbmr.3441] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/28/2018] [Accepted: 04/05/2018] [Indexed: 12/12/2022]
Abstract
Bone morphogenetic proteins (BMPs) are key regulators of skeletal development, growth, and repair. Although BMP signaling is required for synovial joint formation and is also involved in preserving joint function after birth, the role of specific BMP ligands in adult joint homeostasis remains unclear. The purpose of this study was to define the role of Bmp2 in the morphogenesis and maintenance of the knee joint. To do this, we first created Bmp2-LacZ and Gdf5-LacZ knock-in mice and compared their expression patterns in the developing and postnatal murine knee joint. We then generated a knockout mouse model using the Gdf5-cre transgene to specifically delete Bmp2 within synovial joint-forming cells. Joint formation, maturation, and homeostasis were analyzed using histology, immunohistochemistry, qRT-PCR, and atomic force microscopy (AFM)-based nanoindentation to assess the cellular, molecular, and biomechanical changes in meniscus and articular cartilage. Bmp2 is expressed in the articular cartilage and meniscus of the embryonic and adult mouse knee in a pattern distinct from Gdf5. The knee joints of the Bmp2 knockout mice form normally but fail to mature properly. In the absence of Bmp2, the extracellular matrix and shape of the meniscus are altered, resulting in functional deficits in the meniscus and articular cartilage that lead to a progressive osteoarthritis (OA) like knee pathology as the animals age. These findings demonstrate that BMP activity provided by Bmp2 is required for the maturation and maintenance of the murine knee joint and reveal a unique role for Bmp2 that is distinct from Gdf5 in knee joint biology. © 2018 American Society for Bone and Mineral Research.
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Affiliation(s)
- Laura W Gamer
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, MA, USA
| | - Steven Pregizer
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, MA, USA
| | - Jackson Gamer
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, MA, USA
| | - Marina Feigenson
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, MA, USA
| | - Andreia Ionescu
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, MA, USA
| | - Qing Li
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Lin Han
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Vicki Rosen
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, MA, USA
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Han SB, Babu CP, Choi JH, Suh DW, Jang KM. Regeneration of lateral discoid meniscus after arthroscopic partial meniscectomy in an adult patient. Knee Surg Sports Traumatol Arthrosc 2018; 26:2278-2281. [PMID: 29500479 DOI: 10.1007/s00167-018-4884-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 02/28/2018] [Indexed: 11/26/2022]
Abstract
Arthroscopic partial resection is indicated for patients who have symptomatic discoid meniscus with overall satisfactory clinical outcomes. Reports regarding regeneration of discoid meniscus after arthroscopic surgery are limited. There are only two reports for children in the literature. To the authors' knowledge, the present study is the first report in the literature to report regeneration of discoid lateral meniscus after arthroscopic partial meniscectomy in an adult patient. The diagnosis was confirmed by both magnetic resonance imaging and arthroscopy. Surgeons should be aware that regeneration of discoid meniscus can occur in adult as well as pediatric patients.Level of evidence V.
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Affiliation(s)
- Seung-Beom Han
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, 73 Inchon-ro (Anam-dong 5-ga) Seongbuk-gu, Seoul, 02841, South Korea
| | - Chand Pasha Babu
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, 73 Inchon-ro (Anam-dong 5-ga) Seongbuk-gu, Seoul, 02841, South Korea
| | - Jae-Hyuk Choi
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, 73 Inchon-ro (Anam-dong 5-ga) Seongbuk-gu, Seoul, 02841, South Korea
| | - Dong-Won Suh
- Department of Orthopaedic Surgery, Barunsesang Hospital, Seongnam, Gyeonggi-do, South Korea
| | - Ki-Mo Jang
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, 73 Inchon-ro (Anam-dong 5-ga) Seongbuk-gu, Seoul, 02841, South Korea.
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Abstract
The complex ultrastructure of the meniscus determines its vital functions for the knee, the lower extremity, and the body. The most recent concise, reliable, and valid classification system for meniscal tears is the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) Classification, which takes into account the subsequent parameters: tear depth, tear pattern, tear length, tear location/rim width, radial location, location according to the popliteal hiatus, and quality of the meniscal tissue. It is the orthopaedic surgeon’s responsibility to combine clinical information, radiological images, and clinical experience in an effort to individualize management of meniscal tears, taking into account factors related to the patient and lesion. Surgeons should strive not to operate in most cases, but to protect, repair or reconstruct, in order to prevent early development of osteoarthritis by restoring the native structure, function, and biomechanics of the meniscus. Currently, there are three main methods of modern surgical management of meniscus tears: arthroscopic partial meniscectomy; meniscal repair with or without augmentation techniques; and meniscal reconstruction. Meniscus surgery has come a long way from the old slogan, “If it is torn, take it out!” to the currently accepted slogan, “Save the meniscus!” which has guided evolving modern treatment methods for meniscal tears. This last slogan will probably constitute the basis for newer alternative biological treatment methods in the future. Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170067.
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Affiliation(s)
- Mahmut Nedim Doral
- Hacettepe University, Faculty of Medicine, Department of Orthopaedics and Traumatology, Department of Sports Medicine, Ankara, Turkey
| | - Onur Bilge
- Konya N.E. University, Meram Faculty of Medicine, Department of Orthopaedics and Traumatology, Department of Sports Medicine, Konya, Turkey
| | - Gazi Huri
- Hacettepe University, Faculty of Medicine, Department of Orthopaedics and Traumatology, Ankara, Turkey
| | - Egemen Turhan
- Hacettepe University, Faculty of Medicine, Department of Orthopaedics and Traumatology, Ankara, Turkey
| | - René Verdonk
- Ghent University, Faculty of Medicine, Department of Orthopaedics and Traumatology, De Pintelaan, Ghent, Belgium
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Kim YM, Joo YB. Anteromedial Meniscofemoral Ligament of the Anterior Horn of the Medial Meniscus: Clinical, Magnetic Resonance Imaging, and Arthroscopic Features. Arthroscopy 2018; 34:1590-1600. [PMID: 29402584 DOI: 10.1016/j.arthro.2017.12.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 12/05/2017] [Accepted: 12/06/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe the clinical, arthroscopic, and magnetic resonance imaging (MRI) findings of knees with anomalous insertion of the anterior horn of the medial meniscus (AHMM) into the intercondylar notch via an anteromedial meniscofemoral ligament (AMMFL). METHODS A total of 2,503 arthroscopic knee surgeries performed from July 2003 to October 2016 were reviewed retrospectively to identify knees with an AMMFL. Medical records, arthroscopic photographs, and MRI of identified cases were analyzed. Meniscus width and extrusion were measured on MRI. Fifty patients with a normal meniscus were selected as a control group. RESULTS A total of 13 (0.52%) patients had an AMMFL with insertion at the intercondylar notch. All cases were diagnosed incidentally during arthroscopy. The characteristics of knee pain were related to surgical pathology. Arthroscopic examination revealed the AMMFL as a band-like structure covering the anterior cruciate ligament. In all cases, the AHMM had no bony attachment to the tibia, and increased mobility was observed on probing of the AHMM. The medial meniscus (MM) was significantly larger than the general size in 8 cases (61.5%). Twelve knees (92.3%) had meniscus tears. On MRI, the AMMFL appeared as a low-signal linear structure arising at the AHMM and coursing superiorly along the anterior cruciate ligament. The mean MM width was greater than that in the control group at the mid-body (P = .030), anterior horn (P = .002), and posterior horn (P = .001). CONCLUSIONS All cases of AMMFL were found incidentally during arthroscopic surgery, and the AMMFL was a silent lesion. There was no significant meniscal extrusion, although the AHMM had no bony attachment. This is because the AMMFL may act as an anchor for the AHMM. Therefore, the AMMFL should not always be removed. The MM with an AMMFL tended to be larger than the typical MM and may be related to some degree of hypermobility, which raises the risk of meniscal tears. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Young Mo Kim
- Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Yong-Bum Joo
- Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea.
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