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Hagino T, Koizumi R, Hagino T, Ochiai S, Furuya N, Wako M, Haro H. Helix meniscus - A novel anatomical discovery. Knee 2025; 54:240-243. [PMID: 40088569 DOI: 10.1016/j.knee.2025.02.030] [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: 11/03/2024] [Revised: 02/11/2025] [Accepted: 02/27/2025] [Indexed: 03/17/2025]
Abstract
Many anatomical variations of the meniscus have been reported. In this report, we present a case of a novel pattern of meniscal morphology showing a helix structure. A 14-year-old boy presented with knee pain without an apparent cause. Arthroscopic surgery was performed, revealing a helical-shaped meniscus on the lateral side, without injury or degeneration. Partial meniscectomy resulted in symptom improvement. A helix meniscus is very rare and should be recognized as a novel anatomical variant. While arthroscopic meniscectomy improved symptoms, careful consideration is needed when determining surgical indications, as long-term effects remain unknown.
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Affiliation(s)
- Tetsuhiro Hagino
- Department of Orthopaedic Surgery, NHO (National Hospital Organization) Kofu National Hospital, Kofu, Yamanashi, Japan; Department of Orthopaedic Surgery, Interdisciplinary Graduate School of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan.
| | - Ryosuke Koizumi
- Department of Orthopaedic Surgery, Interdisciplinary Graduate School of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Tetsuo Hagino
- Department of Orthopaedic Surgery, NHO (National Hospital Organization) Kofu National Hospital, Kofu, Yamanashi, Japan
| | - Satoshi Ochiai
- Department of Orthopaedic Surgery, NHO (National Hospital Organization) Kofu National Hospital, Kofu, Yamanashi, Japan
| | - Naoto Furuya
- Department of Orthopaedic Surgery, NHO (National Hospital Organization) Kofu National Hospital, Kofu, Yamanashi, Japan
| | - Masanori Wako
- Department of Orthopaedic Surgery, NHO (National Hospital Organization) Kofu National Hospital, Kofu, Yamanashi, Japan; Department of Orthopaedic Surgery, Interdisciplinary Graduate School of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Hirotaka Haro
- Department of Orthopaedic Surgery, Interdisciplinary Graduate School of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
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Vivekanantha P, Thomas R, Kaplan G, Ho M, de Sa D, Kay J. Surgical Management of the Discoid Lateral Meniscus: a Systematic Review of Outcomes. Curr Rev Musculoskelet Med 2025:10.1007/s12178-025-09980-9. [PMID: 40388072 DOI: 10.1007/s12178-025-09980-9] [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] [Accepted: 05/07/2025] [Indexed: 05/20/2025]
Abstract
PURPOSE OF REVIEW The discoid lateral meniscus is an abnormal variant that can lead to pain and mechanical symptoms. This review aims to summarize the clinical outcomes after surgical management of the discoid lateral meniscus. Procedures included saucerization/meniscectomies, repair, or meniscus allograft transplantation. RECENT FINDINGS A total of 52 articles were included, consisting of 4,503 patients (4,784 knees). Weighted preoperative and postoperative Lysholm scores were 57.8 and 88.6, respectively, with 100% of studies (27/27) finding a significant improvement in scores postoperatively. Weighted preoperative and postoperative IKDC scores were 59.6 and 87.3, respectively, with 88.9% of studies (8/9) finding a statistically significant improvement in scores. Weighted preoperative and postoperative Tegner scores were 4.8 and 7.3, respectively, with 100% of studies (5/5) finding a statistically significant improvement in scores postoperatively. Weighted preoperative and postoperative VAS scores were 5.3 and 3.2, respectively, with 100% of studies (5/5) finding a statistically improvement in scores postoperatively. Amongst patients with reported values, 209 (6.6%; range 0-23.7%) suffered retears, while there were 290 reoperations (6.0%; range: 0-36.7%). Complications included persistent pain, mechanical symptoms, or swelling (n = 115; 2-4%). Studies to date have reported good outcomes overall following surgical management of the discoid lateral meniscus, with significant improvements in PROMs. However, retear and reoperation rates within the literature have been reported to be as high as 23.7% and 36.7%, respectively.
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Affiliation(s)
- Prushoth Vivekanantha
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Rhea Thomas
- Michael DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Gabriel Kaplan
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Matthew Ho
- Michael DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Jeffrey Kay
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
- Division of Orthopedic Surgery, McMaster University Medical Centre, 1200 Main St West, Hamilton, ON, L8N 1H4, Canada.
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Shimmyo A, Onishi S, Kanto R, Nakayama H, Yoshiya S, Tachibana T, Iseki T. Combined Meniscal Saucerization and Repair Versus Subtotal Meniscectomy for Symptomatic Discoid Lateral Meniscal Tears in Children and Adolescents. Orthop J Sports Med 2025; 13:23259671241311918. [PMID: 39931636 PMCID: PMC11808750 DOI: 10.1177/23259671241311918] [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: 07/25/2024] [Accepted: 08/30/2024] [Indexed: 02/13/2025] Open
Abstract
Background Meniscal saucerization combined with repair of a symptomatic discoid lateral meniscus (DLM) has been expanding. However, the significance of meniscal saucerization with repair involving complex or degenerative tears remains uncertain. Purpose/Hypothesis The purpose of this study was to assess the radiological and clinical outcomes of saucerization with repair performed for symptomatic DLM tears in children and adolescents in comparison with a historical control cohort undergoing subtotal meniscectomy. It was hypothesized that saucerization with repair would lead to superior outcomes compared with subtotal meniscectomy. Study Design Cohort study; Level of evidence, 3. Methods This study group consisted of 27 knees in 21 patients who underwent saucerization with repair (SR group) between 2011 and 2018, while the historical control group included 22 knees in 20 patients who underwent subtotal meniscectomy (SM group) between 2005 and 2011. Patient age at the time of surgery ranged from 4 to 18 years (mean, 12.1 years). Clinical outcomes were assessed using the Lysholm score. The Tapper and Hoover classification based on Rosenberg view radiographs was adopted, and lateral joint space width was measured as a parameter for cartilage/meniscus preservation. Clinical and radiological results were evaluated preoperatively, 2 years postsurgery, and until the final follow-up. Results The mean follow-up period was 50.6 ± 17.0 months in the SR group and 62.3 ± 41.0 months in the SM group. Lysholm scores significantly improved postoperatively in both groups (P < .001). As for radiological evaluation, a progression in the Tapper and Hoover classification grade and a significant increase in lateral joint space width (P < .001) between the right and left sides were observed in both groups at 2 years postoperatively, with no significant differences between groups. Complications included postoperative retearing in 5 cases (18.5%) from the SR group, and osteochondritis dissecans (OCD) developed after surgery in 1 knee (4%) in the SR group and 6 knees in the SM group (27%), with a significantly higher incidence in the SM group (P = .036). Conclusion Both groups showed progressive postoperative radiographic degeneration, and clinical outcomes also improved in both groups. Based on the incidence of OCD development, saucerization with repair for complex DLM tears showed advantages over subtotal meniscectomy.
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Affiliation(s)
- Airi Shimmyo
- Department of Orthopaedic Surgery, Hyogo Medical University, Hyogo, Japan
| | - Shintaro Onishi
- Department of Orthopaedic Surgery, Nishinomiya Kaisei Hospital, Hyogo, Japan
| | - Ryo Kanto
- Department of Orthopaedic Surgery, Hyogo Medical University, Hyogo, Japan
| | - Hiroshi Nakayama
- Department of Orthopaedic Surgery, Hyogo Medical University, Hyogo, Japan
| | - Shinichi Yoshiya
- Department of Orthopaedic Surgery, Nishinomiya Kaisei Hospital, Hyogo, Japan
| | - Toshiya Tachibana
- Department of Orthopaedic Surgery, Hyogo Medical University, Hyogo, Japan
| | - Tomoya Iseki
- Department of Orthopaedic Surgery, Hyogo Medical University, Hyogo, Japan
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Amiri S, Mirahmadi A, Parvandi A, Moshfegh MZ, Hashemi Abatari SP, Farrokhi M, Hoseini SM, Kazemi SM, Momenzadeh K, Wu JS, Nazarian A. Excellent accuracy of magnetic resonance imaging for diagnosis of discoid meniscus tears: A systematic review and meta-analysis. J Exp Orthop 2024; 11:e12051. [PMID: 38899047 PMCID: PMC11185948 DOI: 10.1002/jeo2.12051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 06/21/2024] Open
Abstract
Purpose The discoid meniscus (DM) is distinguished by its thickened, disc-shaped formation, which extends over the tibial plateau. The likelihood of developing osteoarthritis escalates if a DM tear remains undiagnosed and untreated. While DM tears can be diagnosed through arthroscopy, the high cost, invasive nature and limited availability of this procedure highlight the need for a better diagnostic modality. This study aims to determine the accuracy of magnetic resonance imaging (MRI) in diagnosing DM tears. Methods A systematic review was conducted to gather articles with at least 10 cases on the comparison of MRI and arthroscopy as the gold standard for DM tear diagnosis. Stata and MetaDisc were used to conduct the statistical analysis. The quality of the included studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Results Five diagnostic performance studies, derived from four original research papers involving 305 patients, were evaluated. Based on the pooled data, the sensitivity, specificity, diagnostic odds ratio, positive limit of detection and negative limit of detection were found to be 0.87 (95% confidence interval [CI], 0.82-0.91) and 0.84 (95% CI, 0.75-0.90), 32.88 (95% CI, 5.81-186.02), 5.22 (95% CI, 1.71-15.92) and 0.18 (95% CI, 0.09-0.38), respectively. A hierarchical summary receiver operating characteristic curve with an area under the curve of 0.92 was generated. Conclusion This meta-analysis demonstrates that MRI has excellent sensitivity and specificity for diagnosing DM tears. Despite its lower accuracy compared to arthroscopy, MRI can be used in symptomatic patients as a viable alternative to arthroscopy due to its inherent advantages. Level of Evidence Level IV.
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Affiliation(s)
- Shayan Amiri
- Shohadaye Haftom‐e‐Tir Hospital, Department of Orthopedic, School of MedicineIran University of Medical SciencesTehranIran
| | - Alireza Mirahmadi
- Bone, Joint and Related Tissue Research Center, Akhtar Orthopedic HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Ava Parvandi
- Bone, Joint and Related Tissue Research Center, Akhtar Orthopedic HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Mana Zaker Moshfegh
- Bone, Joint and Related Tissue Research Center, Akhtar Orthopedic HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Seyedeh Pardis Hashemi Abatari
- Bone, Joint and Related Tissue Research Center, Akhtar Orthopedic HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Mehrdad Farrokhi
- Student Research Committee, Department of Epidemiology, School of Public Health and SafetyShahid Beheshti University of Medical SciencesTehranIran
| | - Seyyed Mehdi Hoseini
- Bone, Joint and Related Tissue Research Center, Akhtar Orthopedic HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Seyed Morteza Kazemi
- Bone, Joint and Related Tissue Research Center, Akhtar Orthopedic HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Kaveh Momenzadeh
- Department of Orthopaedic Surgery, Boston Children's Hospital and Harvard Medical School, Bostonthe Musculoskeletal Translational Innovation InitiativeBostonMassachusettsUSA
| | - Jim S. Wu
- Department of Radiology, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMassachusettsUSA
| | - Ara Nazarian
- Department of Orthopaedic Surgery, Boston Children's Hospital and Harvard Medical School, Bostonthe Musculoskeletal Translational Innovation InitiativeBostonMassachusettsUSA
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Cho JH, Kim M, Nam HS, Park SY, Lee YS. Age and medial compartmental OA were important predictors of the lateral compartmental OA in the discoid lateral meniscus: Analysis using machine learning approach. Knee Surg Sports Traumatol Arthrosc 2024; 32:1660-1671. [PMID: 38651559 DOI: 10.1002/ksa.12196] [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: 11/09/2023] [Revised: 03/16/2024] [Accepted: 03/28/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE The objective of this study was to develop a machine learning model that would predict lateral compartment osteoarthritis (OA) in the discoid lateral meniscus (DLM), from which to then identify factors contributing to lateral compartment OA, with a key focus on the patient's age. METHODS Data were collected from 611 patients with symptomatic DLM diagnosed using magnetic resonance imaging between April 2003 and May 2022. Twenty features, including demographic, clinical and radiological data and six algorithms were used to develop the predictive machine learning models. Shapley additive explanation (SHAP) analysis was performed on the best model, in addition to subgroup analyses according to age. RESULTS Extreme gradient boosting classifier was identified as the best prediction model, with an area under the receiver operating characteristic curve (AUROC) of 0.968, the highest among all the models, regardless of age (AUROC of 0.977 in young age and AUROC of 0.937 in old age). In the SHAP analysis, the most predictive feature was age, followed by the presence of medial compartment OA. In the subgroup analysis, the most predictive feature was age in young age, whereas the most predictive feature was the presence of medial compartment OA in old age. CONCLUSION The machine learning model developed in this study showed a high predictive performance with regard to predicting lateral compartment OA of the DLM. Age was identified as the most important factor, followed by medial compartment OA. In subgroup analysis, medial compartmental OA was found to be the most important factor in the older age group, whereas age remained the most important factor in the younger age group. These findings provide insights that may prove useful for the establishment of strategies for the treatment of patients with symptomatic DLM. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Joon Hee Cho
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Korea
| | - Myeongju Kim
- Division of Clinical Medicine, Center for Artificial Intelligence in Healthcare, Seoul National University Bundang Hospital, Seongnam-si, Korea
| | - Hee Seung Nam
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Korea
| | - Seong Yun Park
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Korea
| | - Yong Seuk Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Korea
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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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Ogata Y, Tabuchi K, Kinouchi S, Sato K, Hashida R, Matsuse H, Murotani K, Soejima T, Maeda A, Hiraoka K. Knee extension deficit during gait and knee extensor weakness persisting after saucerization and repair of discoid lateral meniscus tears. Knee 2024; 47:171-178. [PMID: 38401341 DOI: 10.1016/j.knee.2023.12.008] [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: 07/07/2023] [Revised: 11/04/2023] [Accepted: 12/15/2023] [Indexed: 02/26/2024]
Abstract
BACKGROUND Physical function and knee kinematics recovery after discoid lateral meniscus (DLM) tear surgery are essential for a better prognosis. However, these alterations remain unclear. Therefore, this study aimed to investigate changes in physical function and knee kinematics following saucerization and DLM tear repair. METHODS We enrolled 16 patients who underwent saucerization and DLM tear repair. Postoperative changes in knee kinematics during gait, and physical function, were evaluated at 3, 6, and 12 months. RESULTS The peak flexion angle of the operated limb during weight acceptance was significantly higher than that of the contralateral limb at 3 (operated limb: 34.6 ± 8.9°, contralateral limb: 23.7 ± 8.3°; P < 0.01) and 6 months (operated limb: 32.1 ± 9.7°, contralateral limb: 24.6 ± 8.2°; P = 0.03) postoperatively, but not at 12 months (operated limb: 27.1 ± 7.1°, contralateral limb: 23.1 ± 9.5°; P = 0.22) postoperatively. The knee extensor strength of the operated limb was significantly lower than that of the contralateral limb at 3 (operated limb: 1.00 ± 0.59 Nm/kg, contralateral limb: 1.37 ± 0.59 Nm/kg; P = 0.01), 6 (operated limb: 1.22 ± 0.55 Nm/kg, contralateral limb: 1.48 ± 0.60 Nm/kg; P < 0.01), and 12 months (operated limb: 1.39 ± 0.57 Nm/kg, contralateral limb: 1.55 ± 0.64 Nm/kg; P = 0.04) postoperatively. CONCLUSION Knee extension deficits and extensor weakness persisted at 6 months after saucerization and repair of DLM tears. Postoperative rehabilitation should be focused on knee extension function.
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Affiliation(s)
- Yuta Ogata
- Division of Rehabilitation, Kurume University Medical Center, Kurume, Japan; Kurume University, School of Medicine Graduate School, Kurume, Japan
| | - Kosuke Tabuchi
- Department of Orthopaedic Surgery, Kurume University Medical Center, Kurume, Japan.
| | - Shotaro Kinouchi
- Department of Orthopaedic Surgery, Kurume University Medical Center, Kurume, Japan
| | - Koji Sato
- Division of Rehabilitation, Kurume University Medical Center, Kurume, Japan
| | - Ryuki Hashida
- Department of Orthopaedic Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Hiroo Matsuse
- Department of Orthopaedic Surgery, Kurume University School of Medicine, Kurume, Japan
| | | | - Takashi Soejima
- Department of Sports Medicine and Science, Faculty of Human Health, Kurume University, Kurume, Japan
| | - Akira Maeda
- Department of Sports Medicine and Science, Faculty of Human Health, Kurume University, Kurume, Japan; Hakata Knee & Sports Clinic, Fukuoka, Japan
| | - Koji Hiraoka
- Department of Orthopaedic Surgery, Kurume University School of Medicine, Kurume, Japan
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Shen X, Lu M, Liu M, Xie R, Gong S, Yang C, Sun G. Effect of residual volume after surgery of the discoid lateral meniscus on tibiofemoral joint biomechanics: a finite element analysis. J Orthop Surg Res 2024; 19:43. [PMID: 38184619 PMCID: PMC10771657 DOI: 10.1186/s13018-023-04522-w] [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: 11/16/2023] [Accepted: 12/30/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND The purpose of this study was to investigate the influence of different residual meniscus volume on the biomechanics of tibiofemoral joint after discoid lateral meniscus (DLM) surgery by finite element analysis. METHODS A knee joint model was established based on CT and MRI imaging data. The DLM model was divided into five regions according to conventional meniscectomy, with volumes of 15%, 15%, 15%, 15%, 15%, and 40% for each region. Additionally, the DLM model was divided into anterior and posterior parts to obtain ten regions. The DLM was resected according to the design scheme, and together with the intact discoid meniscus, a total of 15 models were obtained. Finite element analysis was conducted to assess shear and pressure trends on the knee joint. RESULTS The study observed significant changes in peak shear stress and compressive stress in the lateral meniscus and lateral femur cartilage. As the meniscus volume decreased, there was an increase in these stresses. Specifically, when the meniscus volume reduced to 40%, there was a sharp increase in shear stress (302%) and compressive stress (152%) on the meniscus, as well as shear stress (195%) and compressive stress (157%) on the lateral femur cartilage. Furthermore, the model grouping results showed that preserving a higher frontal volume in the meniscus model provided better biomechanical advantages. CONCLUSION The use of finite element analysis has demonstrated that preserving more than 55% of the meniscus volume is necessary to prevent a significant increase in joint stress, which can potentially lead to joint degeneration. Additionally, it is crucial to preserve the front volume of the DLM in order to achieve improved knee biomechanical outcomes.
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Affiliation(s)
- Xin Shen
- Department of Sports Medicine, Orthopaedic Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 17, Yongwai Zhengjie, Donghu District, Nanchang City, Jiangxi Province, China
- Department of Osteoarthrosis, The First People's Hospital of Jiujiang, Jiujiang City, Jiangxi Province, China
| | - Meifeng Lu
- Department of Sports Medicine, Orthopaedic Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 17, Yongwai Zhengjie, Donghu District, Nanchang City, Jiangxi Province, China
| | - Muzi Liu
- Department of Osteoarthrosis, The First People's Hospital of Jiujiang, Jiujiang City, Jiangxi Province, China
| | - Ronghui Xie
- Department of Osteoarthrosis, The First People's Hospital of Jiujiang, Jiujiang City, Jiangxi Province, China
| | - Shiguo Gong
- Department of Osteoarthrosis, The First People's Hospital of Jiujiang, Jiujiang City, Jiangxi Province, China
| | - Chunjing Yang
- Department of Medical Imaging, The First People's Hospital of Jiujiang, Jiujiang City, Jiangxi Province, China
| | - Guicai Sun
- Department of Sports Medicine, Orthopaedic Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 17, Yongwai Zhengjie, Donghu District, Nanchang City, Jiangxi Province, China.
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Kinoshita T, Hashimoto Y, Nishino K, Iida K, Nakamura H. Saucerization of complete discoid lateral meniscus is associated with change of morphology of the lateral femoral condyle and tibial plateau. Arch Orthop Trauma Surg 2023; 143:7019-7026. [PMID: 37522940 DOI: 10.1007/s00402-023-04999-4] [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: 02/01/2023] [Accepted: 07/18/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE To determine the effect of saucerization surgery on knee joint morphology associated with a complete discoid lateral meniscus (DLM) using magnetic resonance (MR) imaging. METHODS This retrospective study included cases had undergone saucerization surgery for symptomatic DLM between 2007 and 2022. All cases were divided into two by age group: < 12 (U13) and > 13 (O13). The cases in the match group were randomly selected from preoperative cases in the O13 group matched with the age at the final follow-up (F/U) of cases in the U13 group. The following morphological parameters were evaluated using MR images preoperatively and at the final postoperative F/U in each group: anterior obliquity of the lateral tibial plateau (AOLTP), posterior obliquity of the lateral tibial plateau (POLTP), and the lowest point of the lateral femoral condyle (LPLFC). Each parameter was compared between the U13 preoperative (pre-OP) group and the O13 pre-OP group, the preoperative and final follow-up in the U13, and the U13 group at the final F/U and the match group preoperatively. RESULTS A total of 77 cases were evaluated. 31 cases were in the U13 pre-OP group and 46 were in the O13 pre-OP group. With a minimal F/U of 2 years, 27 cases in the U13 group and 36 in the O13 group were included. The mean F/U period was 4.6 years in the U13 group and 3.2 years in the O13 group. 32 cases were included in the match group. In the match group, the inclination of the POLTP was significantly larger (P = 0.042) and the LPLFC was more lateral (P = 0.0034) than at the final F/U in the U13 group. CONCLUSIONS Saucerization surgery for DLM in juvenile patients can prevent progression to the characteristic bone morphology DLM. These results could help the surgeon making the decision when the surgery would be performed for symptomatic DLM patients. LEVEL OF EVIDENCE Retrospective comparative study; level of evidence, 3.
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Affiliation(s)
- Takuya Kinoshita
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yusuke Hashimoto
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Kazuya Nishino
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Ken Iida
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
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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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Kinoshita T, Hashimoto Y, Iida K, Nakamura H. Evaluation of the knee joint morphology associated with a complete discoid lateral meniscus, as a function of skeletal maturity, using magnetic resonance imaging. Arch Orthop Trauma Surg 2023; 143:2095-2102. [PMID: 35838822 DOI: 10.1007/s00402-022-04538-7] [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: 02/13/2022] [Accepted: 06/28/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION A discoid lateral meniscus (DLM) is associated with increased risk for meniscal tears and progression of knee joint osteoarthritis. Our aim was to differentiate knee joint morphology between patients with and without a DLM, as a function of skeletal maturity, using magnetic (MR) imaging. MATERIALS AND METHODS This was a retrospective analysis of MR images of the knee for 110 patients, 6-49 years of age. Of these, 62 were in the open physis group (38 with a DLM) and 48 in the closed physis group (23 with a DLM). The following morphological parameters were measured: anterior obliquity of the lateral tibial plateau (AOLTP), posterior obliquity of the lateral tibial plateau (POLTP), the lowest point of the lateral femoral condyle (LPLFC), and the posterior lateral condylar angle (PLCA). RESULTS Regardless of skeletal maturity, a DLM was associated with a greater inclination of the POLTP, lateralization of the LPLFC, and smaller PLCA (p < 0.001 for all compared to that of the control group). In the DLM group, the inclination of the AOLTP and the POLTP were significantly smaller (p < 0.001) and the LPLFC was more lateral (p < 0.001) in the closed physis group than in the open physis group. In the control group, the inclination of the POLTP was larger (p < 0.001) and the PLCA smaller (p = 0.019) in the open than in the closed physis group. CONCLUSIONS We identified a characteristic knee morphology among patients with a complete DLM using MR imaging, which was observed before physeal closure and persisted after skeletal maturity was attained. We also noted lateralization of the LPLFC in the presence of a DLM, with an increase in lateralization with skeletal maturation. LEVEL OF EVIDENCE Case-control study, III.
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Affiliation(s)
- Takuya Kinoshita
- Department of Orthopaedic Surgery, Osaka Metropolitan University, Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Yusuke Hashimoto
- Department of Orthopaedic Surgery, Osaka Metropolitan University, Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Ken Iida
- Department of Orthopaedic Surgery, Osaka Metropolitan University, Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka Metropolitan University, Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
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12
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Yokoe T, Ouchi K, Matsumoto T, Tajima T, Chosa E. Effect of the volume of resected discoid lateral meniscus on the contact stress of the tibiofemoral joint: A finite element analysis. Knee 2023; 42:57-63. [PMID: 36905825 DOI: 10.1016/j.knee.2023.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/02/2023] [Accepted: 02/13/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Partial meniscectomy is commonly performed for symptomatic patients with discoid lateral meniscus (DLM) if conservative treatment fails. However, the development of knee osteoarthritis and osteochondral lesion are detrimental postoperative complications. This study aimed to evaluate the effect of the volume of resected DLM on the contact stress of the tibiofemoral joint using a finite element analysis. METHODS Subject-specific finite-element models of the knee joint of a patient with DLM were developed from computed tomographic and magnetic resonance images. To evaluate the effect of partial meniscectomy on the contact stress in the lateral tibiofemoral joint, six knee models were created in the study (the native DLM, and five partially meniscectomized DLMs (according to the preserved width of the meniscus: 12 mm, 10 mm, 8 mm, 6 mm, and 4 mm)). RESULTS As the volume of resected DLM increased, higher contact stress was applied to the lateral tibiofemoral joint. Greater contact stress was applied to the preserved lateral meniscus than to the native DLM. CONCLUSIONS From a biomechanical viewpoint, the native DLM was the most protective against lateral tibiofemoral contact stress in comparison to partially meniscectomized DLMs.
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Affiliation(s)
- Takuji Yokoe
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Koki Ouchi
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
| | - Taisei Matsumoto
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Takuya Tajima
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Etsuo Chosa
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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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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14
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Lee DW, Lee DR, Kim MA, Lee JK, Kim JG. Effect of Preoperative Joint Space Width on Lateral Meniscal Allograft Transplantation: Outcomes at Midterm Follow-up. Orthop J Sports Med 2022; 10:23259671221103845. [PMID: 36081410 PMCID: PMC9445481 DOI: 10.1177/23259671221103845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/23/2022] [Indexed: 11/15/2022] Open
Abstract
Background: It remains unclear whether lateral joint space narrowing without severe cartilage loss before meniscal allograft transplantation (MAT) affects clinical outcomes and graft extrusion. Hypothesis: Patients with greater preoperative joint space narrowing would show more graft extrusion, more osteoarthritis progression, and worse clinical outcomes than would those with less narrowing. Study Design: Case-control study; Level of evidence, 3. Methods: We retrospectively evaluated 61 patients who underwent lateral MAT and had a minimum follow-up of 4 to 5 years. The median preoperative joint space width (JSW) on Rosenberg view radiographs was used to classify patients into those with less joint space narrowing (JSW ≥3 mm; group A) and greater joint space narrowing (JSW <3 mm; group B). We compared differences between groups in terms of graft extrusion and articular cartilage loss (modified Outerbridge grade ≥3) on 1-year postoperative magnetic resonance imaging (MRI) scans and changes in JSW and clinical outcomes at the last follow-up. Results: There were 31 patients in group A and 30 patients in group B; the mean follow-up time for all patients was 64.4 ± 10.3 months. All patients showed a significant preoperative to postoperative improvement in outcome scores (P < .001 for all). The mean preoperative JSW was 3.8 ± 0.9 mm in group A and 2.3 ± 0.4 mm in group B (P < .001). In group B, there was more graft extrusion on postoperative MRI scans (3.0 ± 0.9 vs 1.9 ± 0.6 mm, respectively; P < .001) and a higher proportion of patients with pathological graft extrusion at final follow-up (43.3% vs 12.9%, respectively; P = .011) compared with group A. At 1 year postoperatively, cartilage loss grade ≥3 was observed at the lateral femoral condyle in 3.2% and 20.0% of patients in groups A and B (P = .053), respectively, and at the lateral tibial plateau in 3.2% and 30.0% of patients (P = .006), respectively. There were moderate correlations between graft extrusion and preoperative absolute JSW (r = –0.471; P < .001) and preoperative relative JSW (r = –0.428; P = .001). Conclusion: Patients with less preoperative joint space narrowing had less graft extrusion and cartilage loss on 1-year postoperative MRI scans, as well as better radiological and clinical outcomes at midterm follow-up, compared with patients with greater preoperative narrowing.
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Affiliation(s)
- Dhong Won Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Dong Ryun Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Min Ah Kim
- Department of Orthopaedic Surgery, Myongji Hospital, Goyang, Republic of Korea
| | - Joon Kyu Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jin Goo Kim
- Department of Orthopaedic Surgery, Myongji Hospital, Goyang, Republic of Korea
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Tyler PA, Jain V, Ashraf T, Saifuddin A. Update on imaging of the discoid meniscus. Skeletal Radiol 2022; 51:935-956. [PMID: 34546382 DOI: 10.1007/s00256-021-03910-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/14/2021] [Accepted: 09/14/2021] [Indexed: 02/02/2023]
Abstract
Discoid menisci represent a range of morphological meniscal variants, most commonly involving the lateral meniscus. Clinical presentation ranges from an asymptomatic incidental finding to snapping, pain, swelling and reduced range of knee movement. Symptomatic presentation of discoid menisci is usually due to meniscal tears and instability resulting from abnormal meniscal morphology and ultrastructure, with absent peri-meniscal ligamentous and meniscocapsular attachments characteristic of the Wrisberg sub-type. This article reviews the current classification systems of discoid menisci, gross morphological characteristics of each sub-type and ultrastructure. Clinical presentation, arthroscopic findings and indirect radiological diagnostic criteria are described, as are the MRI findings of normal and pathological discoid menisci. Current concepts of surgical management and outcomes of the discoid meniscus are also briefly discussed.
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Affiliation(s)
- P A Tyler
- Royal National Orthopaedic Hospital, Brockley Hill Stanmore, London, HA7 4LP, UK
| | - V Jain
- Royal National Orthopaedic Hospital, Brockley Hill Stanmore, London, HA7 4LP, UK.
| | - T Ashraf
- The Royal Orthopaedic Hospital & Queen Elizabeth University Hospital, Birmingham, UK
| | - A Saifuddin
- Royal National Orthopaedic Hospital, Brockley Hill Stanmore, London, HA7 4LP, UK
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16
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Clinical presentation, MRI and clinical outcome scores do not accurately predict an important meniscal tear in a symptomatic discoid meniscus. Knee Surg Sports Traumatol Arthrosc 2021; 29:3133-3138. [PMID: 33386884 DOI: 10.1007/s00167-020-06375-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/13/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Discoid menisci can be symptomatic from instability or a tear. A torn discoid meniscus is likely to require repair to preserve meniscal function and should not be missed. This is the first study to evaluate a range of pre-operative methods to predict the likelihood of a torn discoid meniscus. METHODS A retrospective analysis of prospectively collected data was performed. Clinical, radiographic and operative data were reviewed. Patients were grouped based on the presence of a tear or not during surgery. All patients underwent MRI scans pre-operatively which were validated with arthroscopy findings to calculate sensitivity. All patients completed Pedi-KOOS and Pedi-IKDC pre-operative scores. RESULTS There were 32 discoid menisci in 27 patients. Mean age at surgery was 10.4 years (6-16). Nineteen patients were female. Seventeen menisci were identified as torn at time of arthroscopy (53%), 15 were unstable but not torn. Clinical findings did not differentiate between the torn or unstable menisci. MRI was only 75% sensitive and 50% specific at identifying a torn discoid meniscus. There was no statistical difference between KOOS-child (n.s.) and Pedi-IKDC (n.s.) scores between the groups. CONCLUSION MRI is neither sensitive nor specific at identifying tears in discoid menisci. There is no difference in pre-operative outcome scores for patients with a torn or unstable discoid meniscus; pre-operative PROMs are a poor predictor of a meniscal tear. This study emphasises that pre-operative tests and clinical findings are not conclusive for identifying a meniscal tear and the operating surgeon should be vigilant in identifying and repairing tears at the time of surgery. Pre-operative findings poorly correlate to arthroscopic findings and potential surgical interventions required. Patients and parents/carers should, therefore, be appropriately counselled prior to surgery that post-operative measures are dependent on intra-operative findings and not pre-operative findings in patients. LEVEL OF EVIDENCE III.
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17
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Mochizuki T, Tanifuji O, Watanabe S, Sato T, Endo N. The postoperative shorter meniscal width was the risk factor of lateral meniscal extrusion in the middle portion for juvenile and adolescent knees with discoid lateral meniscus. Knee Surg Sports Traumatol Arthrosc 2021; 29:2857-2866. [PMID: 32734331 DOI: 10.1007/s00167-020-06188-x] [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: 03/25/2020] [Accepted: 07/24/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The study aim was to clarify the risk factors for postoperative meniscal extrusion in a middle portion in juvenile and adolescent knees with DLM. METHODS Forty-six patients with symptomatic DLM who underwent surgery were retrospectively assessed. Inclusion criteria were set as follows: (1) aged ≤ 17 years with an open growth plate, (2) preoperative and postoperative follow-up MRI, and 3) reshaping surgeries comprising of saucerization alone or with meniscal repair. Average (95%CI) age during surgery, body mass index (BMI), and follow-up duration were 12 years (11-13), 19.9 kg/m2 (18.7-21.0), and 26.4 months (19.5-33.3), respectively. Age, sex, sports activities, BMI, postoperative rehabilitation, preoperative shift of DLM by Ahn's classification, surgical procedures, postoperative meniscal width of all portions, and meniscal healing were analyzed. RESULTS Postoperatively, eight knees in the no-extrusion group and 38 knees in the extrusion group were observed. In the univariate logistic regression analysis, shorter meniscal width in a middle portion (OR = 1.580, p = 0.006), shorter minimum width of all portions (OR = 1.674, p = 0.024), and meniscal healing (OR = 0.160, p = 0.028) were the risk factors for meniscal extrusion in a middle portion. Multiple logistic regression analysis demonstrated that shorter meniscal width in a middle portion was the risk factor. CONCLUSIONS As the clinical relevance, to prevent postoperative meniscal extrusion of the middle portion with DLM, surgeons are necessary to pay attention to maintain the adequate meniscal width for juvenile and adolescent knees. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Tomoharu Mochizuki
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, 1-757 Asahimachi-dori Chuo-ku, Niigata, Niigata, 951-8510, Japan.
| | - Osamu Tanifuji
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, 1-757 Asahimachi-dori Chuo-ku, Niigata, Niigata, 951-8510, Japan
| | - Satoshi Watanabe
- Department of Orthopaedic Surgery, Niigata Medical Center, 3-27-11, Kobari, Nishi-ku, Niigata, 950-2022, Japan
| | - Takashi Sato
- Department of Orthopaedic Surgery, Niigata Medical Center, 3-27-11, Kobari, Nishi-ku, Niigata, 950-2022, Japan
| | - Naoto Endo
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, 1-757 Asahimachi-dori Chuo-ku, Niigata, Niigata, 951-8510, Japan
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18
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Discoid Lateral Meniscus Saucerization and Treatment of Intrasubstance Degeneration Through an Accessory Medial Portal Using a Small Arthroscope. Arthrosc Tech 2021; 10:e2165-e2171. [PMID: 34504757 PMCID: PMC8417449 DOI: 10.1016/j.eats.2021.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/26/2021] [Indexed: 02/03/2023] Open
Abstract
Discoid lateral meniscus (DLM) is a rare meniscal variant characterized by an increased amount of meniscal tissue that resembles the shape of a disc as opposed to the typical crescent shape of the lateral meniscus. Surgical intervention is recommended for symptomatic DLM with persistent pain, mechanical symptoms, or motion impairment. The technique described is a reliable and reproducible method to identify and treat intrasubstance degeneration (ID) in the setting of DLM. A small arthroscope is used that allows more room for a meniscal repair device, as well as improved visualization and access of the lateral compartment. An accessory medial portal is used that allows perpendicular access to the anterior half of the body, as well as the posterior aspect of the anterior horn for repair. Successful surgery with this technique preserves meniscus and produces a strong reliable all-meniscal based repair of ID that allows early weight bearing and range of motion postoperatively.
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19
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Kamei G, Ishikawa M, Shimizu R, Nakamae A, Adachi N. Simultaneous meniscal reconstruction using semitendinosus tendon and tissue-engineering cartilage implantation for extensive cartilage defect of lateral femoral condyle after lateral meniscus resection: A case report. J Orthop Sci 2021:S0949-2658(20)30361-4. [PMID: 33618942 DOI: 10.1016/j.jos.2020.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/02/2020] [Accepted: 11/22/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Goki Kamei
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Masakazu Ishikawa
- Department of Artificial Joints and Biomaterials, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ryo Shimizu
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Atsuo Nakamae
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 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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Sochacki KR, Safran MR, Abrams GD, Donahue J, Chu C, Sherman SL. Platelet-Rich Plasma Augmentation for Isolated Arthroscopic Meniscal Repairs Leads to Significantly Lower Failure Rates: A Systematic Review of Comparative Studies. Orthop J Sports Med 2020; 8:2325967120964534. [PMID: 33283008 PMCID: PMC7682240 DOI: 10.1177/2325967120964534] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/08/2020] [Indexed: 01/23/2023] Open
Abstract
Background: Studies have reported relatively high failure rates of isolated meniscal repairs. Platelet-rich plasma (PRP) has been suggested as a way to increase growth factors that enhance healing. Purpose: To compare (1) meniscal repair failures and (2) patient-reported outcomes after isolated arthroscopic meniscal repair augmented with and without PRP. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic review was performed using the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines. Multiple databases were searched for studies that compared outcomes of isolated arthroscopic meniscal repair augmented with PRP versus without PRP in human patients. Failures and patient-reported outcome scores were reported for each study and compared between groups. Study heterogeneity was assessed using I2 for each outcome measure before meta-analysis. Study methodological quality was analyzed. Continuous variable data were reported as mean and standard deviation from the mean. Categorical variable data were reported as frequency with percentage. All P values were reported with significance set at P < .05. Results: Five articles were analyzed (274 patients [110 with PRP and 164 without PRP]; 65.8% male; mean age, 29.1 ± 4.6 years; mean follow-up, 29.2 ± 22.1 months). The risk of meniscal repair failure ranged from 4.4% to 26.7% for PRP-augmented repairs and 13.3% to 50.0% for repairs without PRP. Meniscal repairs augmented with PRP had significantly lower failure rates than repairs without PRP (odds ratio, 0.32; 95% CI, 0.12-0.90; P = .03). One of the 5 studies reported significantly higher outcomes in the PRP-augmented group versus the no-PRP group for the International Knee Documentation Committee (IKDC), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Knee injury and Osteoarthritis Outcome Score (KOOS) (P < .05 for all). The remaining 4 studies reported no significant difference between groups with regard to outcomes for the IKDC, Lysholm knee scale, visual analog scale for pain, or Tegner activity level. Conclusion: Although the studies were of mostly of low quality, isolated arthroscopic meniscal repairs augmented with PRP led to significantly lower failure rates (10.8% vs 27.0%; odds ratio, 0.32; P = .03) as compared with repairs without PRP. However, most studies reported no significant differences in patient-reported outcomes.
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Affiliation(s)
- Kyle R Sochacki
- Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, California, USA
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, California, USA
| | - Geoffrey D Abrams
- Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, California, USA
| | - Joseph Donahue
- Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, California, USA
| | - Constance Chu
- Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, California, USA
| | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, California, USA
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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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