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Congenital discoid lateral meniscus in children. A follow-up study and evolution of management
P M Aichroth1, D V Patel, C L Marx
1Westminster Children's Hospital, London, England.
Insights
Discoid lateral meniscus in children often presents with vague symptoms, delaying diagnosis. Surgical outcomes for torn discoid menisci are generally good, with open total meniscectomy often indicated for instability.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Sports Medicine
Background:
- Discoid lateral meniscus is a congenital anomaly affecting knee joint development in children.
- Delayed diagnosis is common due to non-specific symptoms, impacting treatment outcomes.
- Associated conditions like osteochondritis dissecans can complicate management.
Purpose of the Study:
- To evaluate the long-term outcomes of surgical management for symptomatic discoid lateral meniscus in children.
- To assess the efficacy of different surgical techniques, including open total meniscectomy and arthroscopic partial meniscectomy.
- To determine factors influencing treatment success and provide surgical recommendations based on meniscus type and stability.
Main Methods:
- Retrospective review of 52 children (62 knees) with discoid lateral meniscus.
- Analysis of surgical interventions: open total lateral meniscectomy, arthroscopic partial meniscectomy, and observation.
- Assessment of outcomes using Ikeuchi's grading system at an average 5.5-year follow-up.
Main Results:
- A significant delay in diagnosis (mean 24 months) was observed.
- Open total lateral meniscectomy was performed on 48 knees, with 37% excellent and 47% good results.
- Arthroscopic partial meniscectomy showed good outcomes in stable posterior attachments; observation was used for intact menisci.
Conclusions:
- Surgical management of symptomatic torn discoid lateral meniscus in children yields favorable outcomes.
- Open total meniscectomy is effective for unstable discoid menisci, particularly the Wrisberg-ligament type.
- Arthroscopic partial meniscectomy is a viable option for stable discoid menisci, preserving meniscal function.
Abstract:
Fifty-two children with 62 discoid lateral menisci were reviewed at an average follow-up of 5.5 years. Their average age at operation was 10.5 years and the mean delay in diagnosis was 24 months. Most of the children had vague and intermittent symptoms and the classical clunk was demonstrable in only 39% of the knees. An associated osteochondritis dissecans of the lateral femoral condyle was seen in seven knees. Forty-eight knees with symptomatic torn discoid menisci underwent open total lateral meniscectomy, six had arthroscopic partial meniscectomy and eight knees with intact discoid menisci, were left alone. Based on Ikeuchi's grading (Ikeuchi 1982), 37% of the knees had an excellent result, 47% had a good result and 16% had a fair result: none was poor. Arthroscopic partial meniscectomy is recommended only when the posterior attachment of the discoid meniscus is stable. A total meniscectomy is indicated for the Wrisberg-ligament type of discoid meniscus with posterior instability.