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Surgical Management of Medial Discoid Meniscus in Pediatric and Adolescent Patients
Aliya G Feroe1,2, Zaamin B Hussain1,3, Kristen L Stupay1
1Department of Orthopaedic Surgery and Sports Medicine.
Background:
Medial discoid meniscus (MDM) is an exceedingly rare anatomic abnormality that presents similarly to other meniscal pathologies. Symptomatic MDM is typically managed arthroscopically with mixed short-term and long-term outcomes, although the existing knowledge about MDM is limited. The purpose of this study was to describe the presentation and surgical treatment of MDM in pediatric and adolescent patients.
Methods:
Medical records of 12 knees with MDM in 8 pediatric and adolescent patients treated between 1991 and 2016 were reviewed retrospectively for patient characteristics, clinical manifestations, radiographic findings, operative techniques, and surgical outcomes.
Results:
Of the 446 knees diagnosed arthroscopically with discoid menisci, lateral discoid meniscus was noted in 434 knees (97.3%) and MDM was present in 12 knees (2.7%). The MDM series included 8 patients of mean age 13.8 years (range: 7.8 to 19.8), of which 5 were males (63%), and 4 (50%) had bilateral involvement. Of the 11 knees with available clinical records, all cases presented symptomatically (pain, mechanical symptoms); 10 (91%) had concurrent physical exam findings. On intraoperative examination, discoid morphologies were described as complete in 4/8 knees (50%) or incomplete in 4/8 (50%), with associated instability in 6/12 (50%). Meniscal tears were reported in 9 cases (75%)-primarily, horizontal cleavage tears. Saucerization was performed in 11 knees (92%), with medial meniscal repair in 7 (58%), when indicated. Retear of the medial meniscus occurred in 4/11 knees (36%) at a mean of 25.8 months postoperation; 2 knees required revisions. One knee developed arthrofibrosis and underwent arthroscopic lysis of adhesions.
Conclusions:
MDM is a rare diagnosis, representing 3% of all discoid menisci, with a nonspecific clinical manifestation. Operative management of symptomatic MDM typically involves saucerization and meniscal repair, when indicated, for concurrent tears. Symptom resolution is common short-term, but long-term outcomes include recurrent meniscal tears. Subsequent observational studies are important to evaluate long-term outcomes, such as arthritic changes, with the advancement of arthroscopic techniques for meniscal preservation.
Level Of Evidence:
Level IV-retrospective case series.
Insights
Medial discoid meniscus (MDM) is a rare condition in pediatric patients, often presenting with knee pain. Surgical treatment provides short-term relief but carries a risk of recurrent tears and requires further study for long-term outcomes.
Area of Science:
- Orthopedics
- Pediatric Orthopedics
- Sports Medicine
Background:
- Medial discoid meniscus (MDM) is a rare congenital anomaly of the knee.
- It often mimics other meniscal pathologies, leading to diagnostic challenges.
- Existing knowledge on MDM, particularly in pediatric populations, is limited.
Purpose of the Study:
- To describe the clinical presentation of symptomatic medial discoid meniscus in pediatric and adolescent patients.
- To detail the surgical techniques and outcomes for treating MDM in this age group.
Main Methods:
- Retrospective review of 12 knees with MDM in 8 pediatric/adolescent patients (1991-2016).
- Data collected included patient demographics, clinical symptoms, physical exam findings, intraoperative details, and surgical outcomes.
- Level IV evidence: retrospective case series.
Main Results:
- MDM accounted for 2.7% of all discoid menisci diagnosed arthroscopically.
- Patients presented with knee pain and mechanical symptoms; 50% had bilateral involvement.
- Common findings included complete or incomplete discoid morphology, associated instability, and horizontal cleavage tears (75%).
- Saucerization and meniscal repair were common procedures.
- Short-term symptom resolution was frequent, but 36% experienced recurrent medial meniscus tears, with 2 cases requiring revision surgery.
Conclusions:
- Medial discoid meniscus is a rare diagnosis with nonspecific symptoms in pediatric patients.
- Arthroscopic management involving saucerization and repair yields short-term symptom relief.
- Long-term outcomes are concerning due to a significant rate of recurrent tears, necessitating further research into meniscal preservation techniques and long-term sequelae like arthritis.
