scholarly journals OUTCOMES OF DISCOID MENISCUS REPAIRS IN CHILDREN AND ADOLESCENTS

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0003
Author(s):  
Crystal Perkins ◽  
Michael Busch ◽  
Melissa Christino ◽  
S. Clifton Willimon
Keyword(s):  
Lateral Meniscus ◽  
Meniscus Repair ◽  
Meniscus Tear ◽  
Discoid Lateral Meniscus ◽  
Discoid Meniscus ◽  
Tear Pattern ◽  
Reoperation Rates ◽  
Meniscus Surgery

Background: Discoid meniscus tear patterns vary, but typically involve horizontal cleavage tears of the central discoid component with or without anterior or posterior meniscocapsular tears. Classically, the central discoid component is saucerized and meniscocapsular tears are repaired. Recent data suggests that meniscal preservation provides long-term benefits over resection1-2. However, many meniscal transplants are performed secondary to unsalvaged or unsalvageable discoid meniscus tears3. Reoperation rates after meniscus repairs vary greatly4-6, with some series reporting high rates of reinjury and reoperation, but there are no large series of pediatric discoid meniscus repairs in the literature. The purpose of this study is to describe the outcomes of meniscus repair and saucerization in pediatric patients with symptomatic discoid menisci. Methods: A single-institution retrospective review was performed of consecutive pediatric patients with surgical treatment of a discoid meniscus tear over a five-year period. Inclusion criteria were age less than 18 years, a symptomatic torn discoid meniscus treated with knee arthroscopy with meniscus repair, and minimum 4-month follow-up. A chart review was performed to describe tear location, tear pattern, and repair type (inside-out, outside-in, all-inside, and hybrid). Hybrid repair constructs were defined as those that used 2 or more repair types. The primary outcome was revision meniscus surgery. Results: Forty-four patients were identified to meet inclusion criteria. There were 23 males and 21 females with a mean age of 12.4 years (range 5 – 17 years). The right knee was affected in 61% of patients. The lateral meniscus was involved in all patients. Tear patterns included anterior meniscocapsular (19 patients, 43%), posterior meniscocapsular (14 patients, 30%), radial (7 patients, 16%), and bucket-handle (5 patients, 11%). Tears most commonly involved the posterior horn and body (21 patients, 48%) or posterior horn (16 patients, 36%) Arthroscopic meniscus repair was performed in all patients. Forty-three patients (98%) also underwent saucerization. Marrow stimulation, as a biological approach to improve repair healing, was performed in 14 patients (32%). The distribution of repair types and number of sutures for each type is listed in the table below. Mean follow-up was 19 months (range 4 – 70 months). Four patients (9%) underwent revision meniscus surgery following the primary repair, including 2 all-inside repairs and 2 partial meniscectomies. There were no statistically significant differences between patients who did or did not require a secondary surgery with respect to sex, age, tear location, tear pattern, repair type, or number of sutures. During follow-up, 9 patients (20%) had surgery for a symptomatic discoid meniscus in the contralateral knee. Conclusions: Saucerization and repair of discoid lateral meniscus tears in the pediatric population have good outcomes with low rates of reoperation. Appropriate saucerization, followed by an arthroscopic assessment of stability and tear patterns is critical to successful treatment of symptomatic discoid menisci. If tissue quality permits, meniscal preservation should be considered in all patients to avoid the consequences of subtotal meniscectomy. [Table: see text] Manzione M, Pizzutillo PD, Peoples AB, et al. Meniscectomy in children: a long-term follow-up study. Am J Sports Med 1983;11:111-115. Ahn JH, Kim KI, Wang JH, et al. Long-term results of arthroscopic reshaping for symptomatic discoid lateral meniscus in children. Arthroscopy 2015;31(5):867-873. Kocher MS, Tepolt FA, Vavken P. Meniscus transplantation in skeletally immature patients. J Pediatr Orthop B 2016;25(4)343-348. Steadman JR, Matheny LM, Singleton SB, et al. Meniscus suture repair: minimum 10-year outcomes in patients younger than 40 years compared with patients 40 and older. Am J Sports Med 2015;43(9):2222-2227. Paxton ES, Stock MV, Brophy RH. Meniscal repair versus partial meniscectomy: a systematic review comparing reoperation rates and clinical outcomes. Arthroscopy 2011;27(9):1275-1288. Shieh AK, Edmonds EW, Pennock AT. Revision meniscal surgery in children and adolescents: risk factors and mechanisms for failure and subsequent management. Am J Sports Med 2016;44(4):838-843.

scholarly journals Outcomes of Discoid Meniscus Repairs in Children and Adolescents

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0033
Author(s):  
Crystal A. Perkins ◽  
Michael T. Busch ◽  
Melissa A. Christino ◽  
S. Clifton Willimon
Keyword(s):  
Pediatric Patients ◽  
Lateral Meniscus ◽  
Meniscus Repair ◽  
Posterior Horn ◽  
Meniscus Tear ◽  
Inclusion Criteria ◽  
Discoid Meniscus ◽  
Tear Pattern ◽  
Meniscus Surgery

Objectives: Discoid meniscus tear patterns vary, but typically involve horizontal cleavage tears of the central discoid component with or without anterior or posterior meniscocapsular tears. Classically, the central discoid component is saucerized and meniscocapsular tears are repaired. Recent data suggests that meniscal preservation provides long-term benefits over resection1-2. However, many meniscal transplants are performed secondary to unsalvaged or unsalvageable discoid meniscus tears3. Reoperation rates after meniscus repairs vary greatly4-6, with some series reporting high rates of reinjury and reoperation, but there are no large series of pediatric discoid meniscus repairs in the literature. The purpose of this study is to describe the outcomes of meniscus repair and saucerization in pediatric patients with symptomatic discoid menisci. Methods: A single-institution retrospective review was performed of consecutive pediatric patients with surgical treatment of a discoid meniscus tear over a five-year period. Inclusion criteria were age less than 18 years, a symptomatic torn discoid meniscus treated with knee arthroscopy with meniscus repair, and minimum 4-month follow-up. A chart review was performed to describe tear location, tear pattern, and repair type (inside-out, outside-in, all-inside, and hybrid). Hybrid repair constructs were defined as those that used 2 or more repair types. The primary outcome was revision meniscus surgery. Results: Forty-four patients were identified to meet inclusion criteria. There were 23 males and 21 females with a mean age of 12.4 years (range 5 - 17 years). The right knee was affected in 61% of patients. The lateral meniscus was involved in all patients. Tear patterns included anterior meniscocapsular (19 patients, 43%), posterior meniscocapsular (14 patients, 30%), radial (7 patients, 16%), and bucket-handle (5 patients, 11%). Tears most commonly involved the posterior horn and body (21 patients, 48%) or posterior horn (16 patients, 36%) Arthroscopic meniscus repair was performed in all patients. Forty-three patients (98%) also underwent saucerization. Marrow stimulation, as a biological approach to improve repair healing, was performed in 14 patients (32%). The distribution of repair types and number of sutures for each type is listed in the table below. Mean follow-up was 19 months (range 4 - 70 months). Four patients (9%) underwent revision meniscus surgery following the primary repair, including 2 all-inside repairs and 2 partial meniscectomies. There were no statistically significant differences between patients who did or did not require a secondary surgery with respect to sex, age, tear location, tear pattern, repair type, or number of sutures. During follow-up, 9 patients (20%) had surgery for a symptomatic discoid meniscus in the contralateral knee. Conclusion: Saucerization and repair of discoid lateral meniscus tears in the pediatric population have good outcomes with low rates of reoperation. Appropriate saucerization, followed by an arthroscopic assessment of stability and tear patterns is critical to successful treatment of symptomatic discoid menisci. If tissue quality permits, meniscal preservation should be considered in all patients to avoid the consequences of subtotal meniscectomy. [Table: see text]

scholarly journals Long-term Results after Repair of Isolated Meniscus Tears in Patients 18 Years and Younger: An 18-Year Follow-up Study

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0033
Author(s):  
Michella Hagmeijer ◽  
Nicholas I. Kennedy ◽  
Adam J. Tagliero ◽  
Bruce A. Levy ◽  
Michael J. Stuart ◽  
...  
Keyword(s):  
Pediatric Population ◽  
Meniscus Repair ◽  
Long Term Results ◽  
Meniscus Tear ◽  
Meniscus Tears ◽  
Long Term Follow Up ◽  
Final Followup ◽  
Reoperation Rates

Objectives: Meniscus repair is desirable over resection to prevent post-meniscectomy arthritis, especially in young and active patients. However, long-term data is currently lacking following isolated meniscus repair, particularly in the pediatric population. The purpose of this study was to report long-term follow-up of isolated meniscus tears treated by meniscus repair in a pediatric population, and to compare those results to previous mid-term follow-up data reported. We hypothesized that these patients would have satisfactory function and reoperation rates at long-term follow-up. Methods: Patients less than 18 undergoing repair of an isolated (without concomitant ACL injury) meniscus tear performed between 1990 and 2005 were included. At the time of final followup, recurrent tear, reoperations, and IKDC and Tegner scores were determined. With logistic regression, the overall failure between different tear types was calculated. Wilcoxon signed ranks tests were performed to calculate the differences in clinical outcome for different time-points, and Spearman coefficients were calculated for Tegner and IKDC with different variables. Results: At an average followup of 17.6 years (13.1 - 26.0 years), 32 patients with 33 isolated meniscus repairs (29 M: 3F) with an average age of 16.1 (9.9 - 18.7) were included in this study. At early follow-up, complex tears (80%) had a higher overall failure rate compared to simple tears (18.2%). However, no further failures occurred since mid-term follow-up with any tear type. At final follow-up, the average IKDC score was 92.3, which was significantly increased when compared to both preoperative 65.3 (p< 0.0001) and mid-term scores, 90.2 (p= 0.01). However, the average Tegner score (6.5) was significantly lower than both pre-operative 8.3 (p< 0.0001) and mid-term 8.4 (p< 0.0001) scores. There was no correlation for Tegner or IKDC values with any risk factors. Conclusion: In conclusion, this study demonstrates overall good to excellent long-term clinical outcomes following isolated meniscus repair in a pediatric population. Early failure and reoperation rates were variable depending on tear type, with complex multiplanar tears having more failures at short-term follow-up. However, at long-term follow-up, IKDC and Tegner scores were not significantly different for those with complex tears compared to other tear types.

scholarly journals The characteristic findings of an inverted-type discoid lateral meniscus tear: a hidden tear pattern

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Kengo Shimozaki ◽  
Junsuke Nakase ◽  
Yasushi Takata ◽  
Kazuki Asai ◽  
Kazu Toyooka ◽  
...  
Keyword(s):  
Lateral Meniscus ◽  
Meniscus Tear ◽  
Discoid Lateral Meniscus ◽  
Tear Pattern

Discoid Lateral Meniscus

2017 ◽  
Vol 30 (09) ◽  
pp. 854-862 ◽  
Author(s):  
Wen-Li Dai ◽  
Hua Zhang ◽  
Ai-Guo Zhou ◽  
Gang Zhang ◽  
Jian Zhang
Keyword(s):  
Meta Analysis ◽  
Lateral Meniscus ◽  
International Knee Documentation Committee ◽  
Partial Meniscectomy ◽  
Discoid Lateral Meniscus ◽  
Cochrane Database ◽  
Long Term Follow Up ◽  
Dichotomous Outcomes

AbstractPartial and total meniscectomies are the most common treatments for patients with discoid lateral meniscus (DLM). We conducted this study to quantitatively assess and compare the outcomes of partial and total meniscectomies for DLM. We also assessed whether the outcomes differed by the type of DLM, duration of follow-up, and age of patients. We searched PubMed, Embase, and the Cochrane database to identify relevant studies that reported outcomes, including Ikeuchi grade, the International Knee Documentation Committee (IKDC) Subjective Knee score, Lysholm score, or failure rate, in patients who underwent partial and total meniscectomies. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for dichotomous outcomes, whereas mean difference and 95% CIs were calculated for continuous outcomes. Fifteen studies met the inclusion criteria. The overall rate of excellent (E) or good (G) postoperatively was 85.5% (95% CI: 79.5–91.5%). The E or G rate of partial meniscectomy was significantly higher than that of total meniscectomy (OR= 1.97, 95% CI: 1.03–3.75, p = 0.038). Besides, patients younger than 20 years had a significantly higher E or G rate than those older than 20 years. (OR = 3.12, 95% CI: 1.18–8.23, p = 0.022). We also found the E or G rate tended to decrease from short- to long-term follow-up. Our systematic review and meta-analysis showed that that partial meniscectomy could achieve better outcomes compared with total meniscectomy for DLM patients.

Decline in clinical scores at long-term follow-up of arthroscopically treated discoid lateral meniscus in children

2018 ◽  
Vol 26 (10) ◽  
pp. 2906-2911 ◽  
Author(s):  
Jonathan D. Haskel ◽  
Tyler J. Uppstrom ◽  
David M. Dare ◽  
Scott A. Rodeo ◽  
Daniel W. Green
Keyword(s):  
Lateral Meniscus ◽  
Discoid Lateral Meniscus ◽  
Clinical Scores ◽  
Long Term Follow Up

Long-Term Clinical and Radiographic Follow-Up of Total Resection for Discoid Lateral Meniscus

2006 ◽  
Vol 22 (12) ◽  
pp. 1339-1343 ◽  
Author(s):  
Takashi Habata ◽  
Kota Uematsu ◽  
Ryoji Kasanami ◽  
Koji Hattori ◽  
Yoshinori Takakura ◽  
...  
Keyword(s):  
Lateral Meniscus ◽  
Discoid Lateral Meniscus ◽  
Total Resection

scholarly journals High Rate of Recurrent Meniscus Tear and Lateral Compartment Osteoarthritis in Patients Treated for Symptomatic Lateral Discoid Meniscus: A Long-Term Population-Based Study

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0033
Author(s):  
Orlando Sabbag ◽  
Mario Hevesi ◽  
Thomas L. Sanders ◽  
Christopher L. Camp ◽  
Diane L. Dahm ◽  
...  
Keyword(s):  
Lateral Compartment ◽  
Young Age ◽  
Age At Diagnosis ◽  
High Rate ◽  
Meniscus Tear ◽  
Discoid Meniscus ◽  
Long Term Outcome ◽  
Risk Of Progression

Objectives: Little is known about the natural history and long-term outcome of a surgically treated symptomatic lateral discoid meniscus. The goals of this study were to describe the rate and factors associated with recurrent lateral meniscus tears and progression to symptomatic lateral compartment osteoarthritis (OA) in patients surgically treated for a symptomatic lateral discoid meniscus. Patients with surgically treated lateral discoid meniscus have a high incidence of meniscus re-tear and progression to lateral compartment OA. Methods: A large, geographic database was reviewed to identify and confirm patients presenting with symptomatic lateral discoid meniscus between 1998 and 2015. Charts were reviewed to document treatment and outcomes at a minimum clinical follow-up of two years. Results: 70 discoid meniscus patients (30 F, 40 M) with a mean age of 27 years (Range: 2.0-66.0) were followed for an average of 5.8 years (Range 2.0-23.7). Sixty patients underwent surgical management: 49 (82%) patients underwent partial lateral meniscectomy and 11 (18%) underwent meniscus repair (including saucerization). Tear-free survival following surgery was 93% at 2 years, 69% at 5 years, and 40% at 8 years. Overall progression to symptomatic lateral compartment OA in the surgical group was 10% at 2 years, 23% at 5 years, and 48% at 8 years. Of those patients who developed lateral compartment OA, 55% (11/20) had a Kellgren-Lawrence score 2 or greater at last radiographic follow-up. Young age and open growth plates were associated with increased incidence of postoperative re-tear (HR: 0.96, CI: 0.93-0.99, p = 0.01). Increased age at diagnosis and BMI ≥ 30 were associated with increased risk of progression to lateral compartment OA on final radiographs. Conclusion: Patients with a surgically treated lateral discoid meniscus tear had a high rate of recurrent meniscus tear at long-term follow-up (60% at 8 years) that was associated with young age. Approximately 48% of surgically treated patients developed symptomatic lateral compartment OA at eight years from initial presentation. The risk of progression to OA increased with older age at diagnosis and BMI ≥ 30.

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