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Characteristics and Outcomes of Operatively Treated Discoid Lateral Meniscus in Pediatric and Young Adult Patients: A
Jennifer A Sheasley1, Julia C Kirby2, Emily L Niu3
1University of Washington School of Medicine, Seattle, Washington, USA.
Insights
Discoid lateral meniscus (DLM) often presents with locking and snapping in children. Most patients have tears, frequently complex and posterior, with a 13% reoperation rate for persistent symptoms or retears.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Sports Medicine
Background:
- Discoid lateral meniscus (DLM) is the most common congenital meniscus abnormality.
- Tears are frequent, and treatments often lack definitive success, necessitating reoperation.
Purpose of the Study:
- To detail clinical features, surgical findings, treatments, and outcomes for pediatric DLM.
- To analyze complication and reoperation rates in a multi-center North American cohort.
Main Methods:
- A multi-center case series (Level of evidence, 4) included 784 pediatric patients (867 knees) treated for symptomatic DLM (2000-2020).
- Data collected included demographics, symptoms, surgical findings, treatments, complications, and reoperations.
- Statistical analysis involved descriptive statistics and chi-square or Fisher exact tests for comparisons.
Main Results:
- Common symptoms included locking (33%) and snapping (30%) in patients with a mean age of 12 years.
- Tears were present in 76% of knees, often complex (38%) and posterior (41%); 28% had peripheral rim instability.
- Complications occurred in 17% of patients, and 13% required reoperation, typically for persistent symptoms or retears.
Conclusions:
- Locking and snapping are key symptoms of pediatric DLM.
- Complex, posterior tears and peripheral rim instability are common findings.
- A significant rate of complications and reoperations highlights the challenges in managing pediatric DLM.
Background:
Discoid lateral meniscus (DLM) is the most common congenital abnormality of the meniscus. Tears are common; treatment is frequently not definitive, often requiring reoperation.
Purpose:
To report the clinical manifestations, physical characteristics, operative treatments and findings, complications, and reoperations of DLM in pediatric patients from multiple centers across North America.
Study Design:
Case series; Level of evidence, 4.
Methods:
Consecutive patients who underwent treatment for symptomatic DLM at 9 institutions between 2000 and 2020 were included. Patient data, presenting symptoms and signs, surgical findings, treatments rendered, and postoperative complications, including reoperation rates, were collected. Means with ranges and counts with proportions are reported for continuous and categorical variables, respectively, and comparisons were made using either the chi-square or Fisher exact test.
Results:
In total, 784 patients (867 knees) were included with a mean age at diagnosis of 12 years (range, 1-22 years) and a mean follow-up of 22.6 months (range, 0-154 months). Common preoperative symptoms were locking (33%) and snapping (30%). At surgery, tears in the DLM were present in 647 knees (594 patients [76%]); 95 knees (11%) had multiple tears; and in 140 knees, tears extended into >1 zone. Tears, when present, were more common within the posterior horn (41%) or body (34%) than the anterior horn (25%). Peripheral rim instability was reported in 241 knees (28%). Significantly more knees had instability posteriorly (15%; P = .0004) and anteriorly (9%; P = .0013) than along the body (3%). Tear type was most commonly complex (38%) or horizontal (34%). A total of 358 knees in 333 patients with tears (42% of all patients) underwent repair (55% of knees with tears). A total of 175 complications were reported, occurring in 139 knees in 134 patients (17%); 116 of these knees with complications (83%) had a single complication, while 23 (17%) had >1. Of the 784 patients, 105 (13%) underwent reoperation, undergoing 135 additional procedures related to their DLM. Of those, 60 (44%) were repeat arthroscopy and meniscal trim; 40 (30%), arthroscopy and meniscal repair; and 17 (13%), an articular cartilage procedure.
Conclusion:
Locking and snapping were common presenting symptoms. Over three-quarters of patients had meniscal tears, which were most often complex and located posteriorly. Seventeen percent of patients experienced complications, and a sixth of patients with complications had >1. Reoperation was typically for persistent symptoms or meniscal retear.
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