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Discoid lateral meniscus in children: magnetic resonance imaging after arthroscopic resection
Susanne Mayer-Wagner1, Alessandro von Liebe, Annie Horng
1Department of Orthopaedic Surgery, University Hospital of Munich (LMU), Campus Großhadern, Marchioninistr. 15, 81377 Munich, Germany. susanne.mayer@med.uni-muenchen.de
Purpose:
The discoid meniscus is a common meniscal anomaly. Symptomatic discoid menisci treated by arthroscopic surgery were examined preoperatively and postoperatively by magnetic resonance imaging (MRI). Aim of this study was to quantify the amount of meniscal resection when treating discoid meniscus in children by partial meniscectomy. The hypothesis was that partial meniscectomy left sufficient amounts of meniscal tissue.
Methods:
A quantitative evaluation of meniscal size comparing preoperative and postoperative data after partial meniscectomy was performed by MRI (n = 6). The anteroposterior meniscal diameter and anterior and posterior thickness were measured. The relative postoperative thickness to preoperative thickness was defined. All patients were graded according to Lysholm score and Ikeuchi knee scale.
Results:
The quantitative MRI evaluation showed a pronounced reduction of the anteroposterior meniscal diameter (42%) and anterior thickness (41%) after partial meniscectomy, whereas the posterior thickness showed a mean increase of 50%. According to Ikeuchi, all clinical postoperative findings were excellent and displayed an increase in Lysholm score.
Conclusions:
MRI findings showed that the amount of remaining tissue after partial meniscectomy was smaller than aspired. Especially in the anterior joint, the final size of remaining meniscal tissue was overestimated intraoperatively. It may be concluded that in arthroscopic partial meniscectomy, the final meniscal size, especially in the anterior part of the joint, is difficult to assess. As it is known that the extent of meniscal resection plays a crucial role in the clinical course of discoid menisci, these data claim retentiveness in resecting meniscal tissue.
Insights
Partial meniscectomy for pediatric discoid meniscus may resect more tissue than intended, particularly in the anterior knee. Careful assessment during arthroscopic surgery is crucial to preserve adequate meniscal tissue for optimal outcomes.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Sports medicine
Background:
- The discoid meniscus is a common congenital anomaly leading to knee pain and instability in children.
- Arthroscopic partial meniscectomy is a standard surgical treatment for symptomatic discoid meniscus.
- Accurate assessment of remaining meniscal tissue is vital for long-term joint health.
Purpose of the Study:
- To quantitatively assess the amount of meniscal tissue resected during arthroscopic partial meniscectomy for pediatric discoid meniscus using MRI.
- To evaluate the hypothesis that partial meniscectomy leaves sufficient meniscal tissue postoperatively.
Main Methods:
- Preoperative and postoperative MRI scans were used to measure meniscal dimensions (anteroposterior diameter, anterior and posterior thickness) in 6 pediatric patients.
- Relative changes in meniscal thickness were calculated.
- Clinical outcomes were assessed using the Lysholm score and Ikeuchi knee scale.
Main Results:
- MRI revealed a significant reduction in anteroposterior meniscal diameter (42%) and anterior thickness (41%) after surgery.
- Posterior meniscal thickness unexpectedly increased by a mean of 50%.
- All patients demonstrated excellent clinical results with improved Lysholm scores.
Conclusions:
- Postoperative MRI indicated that less meniscal tissue remained than anticipated, with overestimation of anterior joint tissue during surgery.
- The precise assessment of remaining meniscal tissue, especially anteriorly, is challenging during arthroscopic partial meniscectomy.
- These findings underscore the need for conservative resection to prevent potential long-term complications associated with excessive meniscal removal.
