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Arthroscopic Treatment for Symptomatic Discoid Meniscus in Children: Midterm Outcomes and Prognostic Factors
Won Joon Yoo1, Woo Young Jang1, Moon Seok Park2
1Division of Pediatric Orthopedic Surgery, Seoul National University Children's Hospital, Seoul, Republic of Korea.
Purpose:
To investigate the clinical and radiologic outcomes and prognostic factors of arthroscopic partial meniscectomy with or without suture repair of the remnant rim and subtotal meniscectomy in children with discoid menisci.
Methods:
We retrospectively reviewed all consecutive patients aged younger than 18 years who underwent arthroscopy between 2003 and 2012, excluding patients with follow-up less than 2 years, concomitant injuries, underlying diseases, or a lost videotape. Patients were grouped by treatment method: partial meniscectomy with or without suture repair and subtotal meniscectomy. Clinical outcomes were determined based on symptoms, complications, and Lysholm scores. Degenerative changes were assessed radiologically. Risk factors for a lower Lysholm score were investigated.
Results:
Of 100 knees (86 patients; mean age, 10.7 years), 87 underwent partial meniscectomy with (n = 42) or without (n = 45) suture repair and 13 underwent subtotal meniscectomy. The Lysholm score at a mean of 4.7 years (range, 2.0 to 10.9 years) improved to more than 90, regardless of meniscectomy method (P = .767; 95% confidence interval [CI], -5.1 to 6.9) or the addition of suture repair (P = .797; 95% CI, -3.5 to 4.6). Early degenerative changes were found in 11 knees. Patients aged younger than 10 years at surgery had a 2.37 times higher chance of having excellent Lysholm scores (P = .032; 95% CI, 1.1 to 5.1). A reoperation history was associated with lower Lysholm scores with a marginal significance (P = .054; 95% CI, -0.9 to 12.3).
Conclusions:
Arthroscopic partial meniscectomy with stabilization of the unstable remnant rim was effective in preserving knee function with few early degenerative changes during the midterm follow-up period. Subtotal meniscectomy appears to be a valid treatment for unsalvageable cases. There was no difference in outcomes among the partial meniscectomy, partial meniscectomy with suture repair, and subtotal meniscectomy groups. Less satisfactory functional outcomes may follow in children aged 10 years or older or when a reoperation has been performed.
Level Of Evidence:
Level IV, therapeutic case series.
