MRI diagnostic performance and strategies for identifying retears in treated pediatric discoid and non-discoid
Jason Zarahi Amaral1, Rida Salman2, Scott D McKay1
1Department of Orthopaedic Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.
Abstract:
Magnetic resonance imaging (MRI) plays a role in assessing retears of previously treated lateral menisci (LM). We aim to characterize the rate and pattern of arthroscopically confirmed LM retears in children with and without discoid morphology. 288 patients (312 knees) who underwent arthroscopic repair of isolated LM tears between 2018 and 2023 were identified. 20 patients (21 knees) had arthroscopically confirmed isolated LM retear. This included 11 retears of discoid lateral meniscus (DLM) and 10 retears of non-DLM. MRI correctly identified retear in 81.8% of DLM cases (n = 9) and 100% of non-DLM cases (overall 90.5%, P = 0.476). 78% of DLM cases (n = 7) had residual discoid elements. MRI is highly accurate in diagnosing retears in isolated LM injuries (90.5%). We suggest that the radiological approach to assessing meniscal retears can be similarly applied to treated discoid and non-discoid menisci. However, special attention to residual discoid elements is crucial in previously treated DLMs.
Insights
Magnetic resonance imaging (MRI) accurately detects lateral meniscus retears in children, including those with discoid morphology. This imaging approach is reliable for assessing both discoid lateral meniscus and non-discoid lateral meniscus retears after surgical repair.
Area of Science:
- Orthopedic Surgery
- Radiology
- Pediatric Sports Medicine
Background:
- Lateral meniscus (LM) tears are common in children, often requiring surgical repair.
- Assessing retears after initial treatment is crucial for patient outcomes.
- Discoid lateral meniscus (DLM) morphology presents unique challenges in diagnosis and management.
Purpose of the Study:
- To determine the rate and pattern of arthroscopically confirmed LM retears in pediatric patients.
- To compare the accuracy of MRI in diagnosing LM retears in patients with and without discoid morphology.
- To evaluate the presence of residual discoid elements on MRI in patients with DLM retears.
Main Methods:
- Retrospective review of 288 patients (312 knees) who underwent arthroscopic repair of isolated LM tears (2018-2023).
- Analysis of 20 patients (21 knees) with arthroscopically confirmed isolated LM retear.
- Comparison of MRI findings with arthroscopic confirmation for retear detection and assessment of residual discoid elements.
Main Results:
- Twenty-one isolated LM retears were identified, including 11 DLM and 10 non-DLM.
- MRI demonstrated high accuracy in diagnosing LM retears (90.5% overall).
- MRI correctly identified retears in 81.8% of DLM cases and 100% of non-DLM cases.
- Residual discoid elements were present in 78% of DLM retear cases.
Conclusions:
- MRI is a highly accurate tool for diagnosing retears in previously treated isolated lateral meniscus injuries.
- The radiological approach for assessing meniscal retears can be applied similarly to both treated discoid and non-discoid menisci.
- Careful attention to residual discoid elements is essential when evaluating previously treated discoid lateral menisci with MRI.
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