Determinants for Aggressive Discoid Lateral Meniscus Saucerization: Evidence for Bias or Just Experience?

In the setting of discoid lateral meniscus (DLM) surgery, the amount of discoid tissue to resect may depend on several factors. The goal of this study is to determine whether the amount of DLM resection during saucerization is impacted by surgeon implicit bias.

A retrospective review of patient demographic information, including race, ethnicity, state normalized child opportunity index (COI), and preferred language, was performed on patients who underwent surgery for discoid lateral meniscus. Treating surgeons were grouped according to experience (trained before or after the popularity of all-inside repair implantation devices). Static arthroscopic images were utilized to detail the meniscus based on a modified Pediatric Research in Sports Medicine (PRiSM) DLM classification system, as well as to record the amount of resection performed. A multivariate generalized linear mixed model (GLMM) was used to evaluate risk factors.

295 children (315 knees) met criteria with a mean age at surgery of 13.2 ± 3.6 years (range: 2.6-21.5 years). 64.1% were Hispanic, and 57.1% had government insurance. Patients managed by more experienced surgeons were 4.6 times more likely to be treated with more aggressive saucerization (P < .001). Arthroscopic findings more likely to be treated via aggressive resection included abnormal meniscal height (OR 1.8; P = .022) and unstable discoid menisci (OR 1.7; P = .028). Compared to non-horizontal tears, those menisci with horizontal tears and those without a tear were more likely to be treated via more aggressive saucerization (ORs 2.3; P = .016 and 2.9; P = .001 respectively).

The PRiSM DLM classification appears to differentiate the extent of discoid saucerization utilized during surgery; however, neither patient race nor ethnicity was a significant predictor. There is a potential unconscious bias related to surgeon experience, as those with more experience tended to be more aggressive with saucerization than surgeons who trained more recently. The positive or negative nature of this bias requires a future long-term outcome study.

(1)The PRiSM DLM classification appears to differentiate the extent of discoid saucerization utilized during surgery.(2)There is a potential unconscious bias related to surgeon experience, as those with more experience tended to be more aggressive with saucerization than surgeons who trained more recently.(3)Abnormal meniscal height, unstable menisci, non-horizontal tears, and tears extending into both the anterior and posterior zones were found to be treated with more aggressive saucerization.

Level III, retrospective study.