scholarly journals NATIONWIDE ETHNIC/RACIAL DIFFERENCES IN SURGICAL TREATMENT OF DISCOID MENISCUS IN CHILDREN: A PHIS DATABASE STUDY

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0005
Author(s):  
Matthew D. Milewski ◽  
Ryan P. Coene ◽  
Kelly H. McFarlane ◽  
Kathryn A. Williams ◽  
Lanna Feldman ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Racial Differences ◽  
Pediatric Patients ◽  
Medial Meniscus ◽  
Meniscal Tear ◽  
Health Information System ◽  
Meniscus Tear ◽  
Latino Children ◽  
Discoid Meniscus ◽  
White Patients

Background: Discoid meniscus, a congenital meniscus variant, may have greater incidence in Asian populations. No United States population-based studies have examined the discoid meniscus ethnic/racial distribution. Hypothesis/Purpose: In pediatric patients undergoing meniscus surgery, we hypothesize that ethnic/racial variability exists in patients with discoid meniscus and this variability is different than in patients with isolated medial meniscus tears. Methods: The Pediatric Health Information System (PHIS) was queried from 48 hospitals to examine patients 18 years of age and younger between 2015 and 2019, using ICD-10 codes. A cohort of patients treated surgically for discoid meniscus was compared to a cohort of patients treated surgically for medial meniscal tear. These two populations were compared based on age, gender, ethnicity/race, CPT® code, insurance, urban vs rural, and region of country. Univariate testing and multivariable logistic modeling were used to test for associations. Results: A discoid meniscus cohort of 399 children (median age, 13.0 years) was compared to a medial meniscus tear cohort of 3157 children (median age, 16.0 years) (p<0.001) (Table 1). Hispanic/Latino children accounted for 36.8% of the discoid meniscus and 22.7% of the medial meniscus populations (p<0.001). Among pediatric patients that had surgery for discoid meniscus or medial meniscus, Hispanic/Latino children had 2.4 times the odds of surgery for discoid meniscus compared to white patients after adjusting for age and insurance (p<0.001) (Table 2). Asian children also had 2.4 times the odds of surgery for discoid meniscus compared to white patients (p=0.017). Conclusion: This study shows a significant association of ethnicity/race with discoid versus medial meniscus surgical treatment in children. Among pediatric patients that had surgery for discoid or medial meniscus, Hispanic/Latino and Asian patients were significantly more likely to have surgery for discoid meniscus than white patients. Hispanic/Latino children made up a greater percentage of the population having surgery for a discoid meniscus versus medial meniscus. When evaluating pediatric patients, younger age and Asian or Hispanic/Latino ethnicity should increase attention to the possibility of a discoid meniscus. [Table: see text][Table: see text]

Nationwide Ethnic/Racial Differences in Surgical Treatment of Discoid Meniscus in Children

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Matthew D. Milewski ◽  
Ryan P. Coene ◽  
Kelly H. McFarlane ◽  
Kathryn A. Williams ◽  
Lanna Feldman ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Racial Differences ◽  
Discoid Meniscus

Correlation of Meniscal Tear with Timing of Anterior Cruciate Ligament Reconstruction in Patients without Initially Concurrent Meniscal Tear

2018 ◽  
Vol 32 (11) ◽  
pp. 1128-1132
Author(s):  
Kun-Hui Chen ◽  
En-Rung Chiang ◽  
Hsin-Yi Wang ◽  
Hsiao-Li Ma
Keyword(s):  
Medial Meniscus ◽  
Cruciate Ligament ◽  
Meniscal Tear ◽  
Lateral Meniscus ◽  
Acl Injury ◽  
Meniscus Tear ◽  
Meniscal Tears ◽  
Anterior Cruciate ◽  
Late Group ◽  
Acl Deficient

AbstractThe incidence of meniscal tear was reported to increase with the delay of anterior cruciate ligament reconstruction (ACLR). The tear may occur concurrently with the ACL injury or after the ACL injury. Few studies had focused on the patients whose meniscus is intact during ACL injury. We determined the correlation between timing of surgery and incidence of meniscal tears in ACL-deficient knees with initially intact meniscus. We retrospectively reviewed 387 patients who had undergone primary ACLR. Time of initial ACL injury, magnetic resonance imaging (MRI) examination, and surgery was recorded. The MRI was reviewed by experienced radiologic and orthopaedic doctors. Intraoperative arthroscopic images were also obtained and reviewed. The type of tear noted during surgery was classified according to the modification of International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine classification of meniscal tears. Patients were divided into early (surgery within 12 months from injury) and late surgery group (surgery at more than 12 months from injury). There were 216 patients with intact medial meniscus and 257 patients with intact lateral meniscus on the postinjury MRI study. The incidence of medial meniscus tear (MMT) was significantly higher than lateral meniscus tear (LMT) during the ACLR (33.8 vs. 19.8%, p < 0.001). The incidence of MMT is higher in late group than in early group (53.7 vs. 29.1%, p = 0.004, odds ratio= 2.815). The incidence of LMT is mildly higher in late group but without statistics significance (23.8 vs. 18.6%, p = 0.364). In both MMT and LMT, the most common injury pattern observed was a longitudinal tear. The incidence of each type is not different between early and late group. For patients without concurrent meniscal injuries with the ACL tear, the incidence of MMT significantly increased if ACLR was performed more than 12 months after injury. The medial meniscus was more prone to injury than the lateral meniscus in chronic ACL-deficient knee. ACLR should be performed earlier to reduce the risk of meniscal tears for patients without initially concurrent meniscal tear.

scholarly journals CONCOMITANT MENISCECTOMY RESULTS IN REDUCED RETURN TO SPORT COMPARED TO MENISCUS REPAIR IN PRIMARY PEDIATRIC ACL RECONSTRUCTION

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0007
Author(s):  
Brendan A. Williams ◽  
Maggie L. Wright ◽  
Joshua T. Bram ◽  
Kathleen J. Maguire ◽  
Neeraj M. Patel ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Pediatric Patients ◽  
Meniscal Tear ◽  
Meniscal Repair ◽  
Return To Sport ◽  
Meniscus Repair ◽  
Meniscus Tear ◽  
Initial Contact ◽  
Severity Of Injury ◽  
The Impact

Background: Meniscus repair has demonstrated favorable outcomes when performed with ACL reconstruction (ACLR). However, literature comparing meniscal tear patterns, treatments, and outcomes among pediatric patients remains limited. Purpose: The aim of this study is to evaluate the impact of surgical technique on patient outcomes, in primary pediatric ACLR with associated meniscal pathology. We secondarily examined patient factors and tear characteristics on these outcomes. Methods: This is a retrospective cohort study from 2014-2016 of pediatric ACL reconstruction patients who underwent concurrent surgical management of a meniscus tear. Predictors included patient demographics, injury mechanism, meniscal tear characteristics and surgical treatments. Clinical outcomes including return to sport (RTS), meniscus or ACL graft re-tear, and return to surgery were assessed via patient cross-sectional survey. Criteria for RTS were based on standardized postoperative rehabilitation protocols. Univariate and multivariate analyses were used to examine the relationship between studied predictors with the likelihood of RTS and other outcomes. Results: Inclusion criteria were met by 123 patients with an average follow-up time of 2.5 ± 0.7 years. RTS was achieved by 80.8% of patients while 17.1% of patients had a subsequent knee surgery within the studied timeframe. Univariate analysis of factors associated with successful RTS are shown in Table 1. While patients failing to RTS were shown to have delayed surgical intervention in univariate testing, multivariate analysis identified that patients who underwent meniscectomy were less likely to RTS than those who underwent meniscal repair (OR=2.690, 95% CI 1.044-6.930, p=0.040). Patients with an initial contact mechanism of injury were also demonstrated to be more likely to return to the OR for any reason (OR=13.443, CI 1.736-104.108, p=0.013) in multivariate modeling. Conclusion: In one of the few large cohorts of pediatric ACL reconstructions with concomitant meniscus surgery, this study adds to our understanding of a potentially modifiable factor (meniscus repair) in the surgical treatment of ACL injury with concaminant meniscus tear. Although no differences were seen in rates of meniscus or graft re-tear when comparing treatments, patients who underwent meniscal repair were more likely to return to sport than patients treated with meniscectomy. While these findings may reflect the quality of the torn meniscal tissue and severity of injury, it further emphasizes the importance of meniscal preservation not just for long term joint quality, but also for short term function in active pediatric patients. [Table: see text]

scholarly journals Ipsilateral Medial and Lateral Discoid Meniscus with Medial Meniscus Tear

2016 ◽  
Vol 6 (4) ◽  
pp. 9-12 ◽  
Author(s):  
Kengo Shimozaki ◽  
Junsuke Nakase ◽  
Yoshinori Ohashi ◽  
Hitoaki Numata ◽  
Takeshi Oshima ◽  
...  
Keyword(s):  
Medial Meniscus ◽  
Meniscus Tear ◽  
Discoid Meniscus

scholarly journals MEDIAL MENISCAL TEAR

2021 ◽  
Vol 10 (4) ◽  
pp. 3340-3342
Author(s):  
Om C. Wadhokar
Keyword(s):  
Knee Joint ◽  
Medial Meniscus ◽  
Meniscal Tear ◽  
Lateral Meniscus ◽  
Meniscus Tear ◽  
Physiotherapy Treatment ◽  
Medial Side ◽  
Healthy Cartilage ◽  
Medial Meniscal Tear ◽  
Time Restriction

Knee joint is type of hinge joint Knee joint consist of medial menisci and lateral menisci. Menisci plays an important role to maintain healthy cartilage. Medial meniscus commonly injured than lateral meniscus due to it is relatively lack of mobility. A case of 32 year female is presented in this report. Patient complaints of pain in medial side of right knee joint, inability to stand for longer time, restriction in daily activities. McMurray test was done and diagnosed medial meniscus tear. Physiotherapy treatment is mentioned in this report. The study conclude that there is significant improvement in range of motion , muscle strength , can able to perform activities of daily living with the help of physiotherapy treatment without any surgical approach.

scholarly journals The relationship between chondromalacia patella, medial meniscal tear and medial periarticular bursitis in patients with osteoarthritis

2017 ◽  
Vol 51 (4) ◽  
pp. 401-406 ◽  
Author(s):  
Mustafa Resorlu ◽  
Davut Doner ◽  
Ozan Karatag ◽  
Canan Akgun Toprak
Keyword(s):  
Medial Meniscus ◽  
Meniscal Tear ◽  
Lateral Collateral Ligament ◽  
Lateral Compartment ◽  
Medial Compartment ◽  
Meniscus Tear ◽  
Collateral Ligament ◽  
Medial Meniscal Tear ◽  
Chondromalacia Patella ◽  
Grade Iii

Abstract Background This study investigated the presence of bursitis in the medial compartment of the knee (pes anserine, semimembranosus-tibial collateral ligament, and medial collateral ligament bursa) in osteoarthritis, chondromalacia patella and medial meniscal tears. Patients and methods Radiological findings of 100 patients undergoing magnetic resonance imaging with a preliminary diagnosis of knee pain were retrospectively evaluated by two radiologists. The first radiologist assessed all patients in terms of osteoarthritis, chondromalacia patella and medial meniscal tear. The second radiologist was blinded to these results and assessed the presence of bursitis in all patients. Results Mild osteoarthritis (grade I and II) was determined in 55 patients and severe osteoarthritis (grade III and IV) in 45 cases. At retropatellar cartilage evaluation, 25 patients were assessed as normal, while 29 patients were diagnosed with mild chondromalacia patella (grade I and II) and 46 with severe chondromalacia patella (grade III and IV). Medial meniscus tear was determined in 51 patients. Severe osteoarthritis and chondromalacia patella were positively correlated with meniscal tear (p < 0.001 and p = 0.018, respectively). Significant correlation was observed between medial meniscal tear and bursitis in the medial compartment (p = 0.038). Presence of medial periarticular bursitis was positively correlated with severity of osteoarthritis but exhibited no correlation with chondromalacia patella (p = 0.023 and p = 0.479, respectively). Evaluation of lateral compartment bursae revealed lateral collateral ligament bursitis in 2 patients and iliotibial bursitis in 5 patients. Conclusions We observed a greater prevalence of bursitis in the medial compartment of the knee in patients with severe osteoarthritis and medial meniscus tear.

scholarly journals Epidemiology, Injury Patterns, and Treatment of Meniscal Tears in Pediatric Patients: A 16-Year Experience of a Single Center

2019 ◽  
Vol 7 (12) ◽  
pp. 232596711989032 ◽  
Author(s):  
Taylor Jackson ◽  
Peter D. Fabricant ◽  
Nicholas Beck ◽  
Eileen Storey ◽  
Neeraj M. Patel ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Meniscal Tear ◽  
Lateral Meniscus ◽  
Meniscal Tears ◽  
Injury Patterns ◽  
Discoid Meniscus ◽  
Male And Female ◽  
Female Patients ◽  
Treatment Type ◽  
Male Patients

Background: Meniscal injuries in children continue to increase, which may be attributable to increasing levels of athletic participation and may be associated with additional injuries or need for additional surgeries. Purpose: To better understand the patterns of pediatric meniscal injuries by analyzing tear location, morphologic features, and associated injury patterns over a 16-year period. Study Design: Case series; Level of evidence, 4. Methods: Pediatric patients were identified and were included in the study if age at the time of initial surgery for meniscal tear was between 5 and 14 years for female patients and 5 and 16 years for male patients. Patients were observed until age 18, and any subsequent surgeries were noted. Demographic factors, tear type and location, associated injuries, and treatment type were analyzed. Results: Mean patient age at surgery was 13.3 years, and 37% of patients were female. A total of 1040 arthroscopic meniscal surgeries in 880 pediatric patients were evaluated. There were 160 reoperations in 138 patients, representing a reoperation rate of 15%. These included 98 reoperations on the ipsilateral knee in 88 patients and 62 operations for injuries to the contralateral knee in 50 patients; 53% of surgeries were meniscal repair, as opposed to partial meniscectomy, and the most common technique was an all-inside repair (91%). Significant differences were identified between male and female patients. Male patients were more likely to have lateral meniscus (74% vs 65%), posterior horn (71% vs 60%), peripheral (45% vs 30%), and vertical tears (31% vs 21%); concomitant ACL injury (50% vs 40%); and an associated osteochondritis dissecans lesion (7% vs 4%). Female patients were more likely to have medial meniscus (24% vs 17%), anterior horn (25% vs 15%), and degenerative tears (34% vs 26%); discoid meniscus (33% vs 24%); and isolated meniscal tears (47% vs 33%). Conclusion: This evaluation of a large series of patients has helped characterize injury patterns associated with pediatric meniscal surgeries. Most meniscal tears were repaired (53%) and were associated with additional injuries (62%), especially anterior cruciate ligament injuries (48%). More than 25% of patients had a discoid meniscus. Injury patterns differed significantly between male and female patients.

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 Development of OA Following ACL Reconstruction: Unexpected Finding in Medial Versus Lateral Meniscus Pathology

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0036
Author(s):  
Karen Briggs ◽  
Stephanie Petterson ◽  
Kevin Plancher
Keyword(s):  
Medial Meniscus ◽  
Meniscal Tear ◽  
Lateral Meniscus ◽  
Meniscal Repair ◽  
Meniscus Tear ◽  
Meniscus Tears ◽  
Medial Meniscal Tear ◽  
Lateral Meniscectomy ◽  
Meniscal Pathology

Objectives: Recent studies have described increased risk of OA following ACL reconstruction (ACLR). Systematic reviews have suggested that meniscal pathology, which occurs in up to 60% of patients with ACL injury, increases this risk. The literature reports a 50% incidence of OA following medial meniscectomy, two times the risk compared to lateral meniscectomy. The purpose of this study was to determine the influence of meniscal pathology on the incidence of OA following ACLR. Methods: All patients who underwent primary autograft or allograft BPTB transtibial ACLR by a single surgeon between 1999-2015 were identified. Revision ACLR, multi-ligamentous reconstructions, and patients with less than 2-year imaging follow-up were excluded. Meniscus pathology and treatment were recorded. OA was defined at follow-up as Kellgren-Lawrence grade III-IV on plain radiographs. Chi-square tests assessed differences in incidence rates (p<0.05). Results: A consecutive series of 103 patients (56 males, 47 females; age 36.1±11.4 years) with BPTB ACLR with an average follow-up of 8.81±4.96 (range 2-20 years) were included. The prevalence of medial meniscus tears at the time of ACL injury was 47.6% (49/103) and prevalence of lateral meniscus tears was 56.3% (58/103) (p=0.166). Medial compartment OA was seen in 9.7% (10/103) of patients. Prevalence of medial compartment OA was greater in patients with medial meniscus tear (14.3%; 7/49) compared to those without a medial meniscus tear (5.6%; 3/54); however, this was not significant (p=0.135). Of the 7 patients with medial meniscal tear and medial compartment OA, 5 underwent partial medial meniscectomy and 2 underwent repair. Lateral compartment OA was seen in 14.6% (15/103). The prevalence of lateral compartment OA was greater in patients with a lateral meniscus tear (22.4%; 13/58) compared to patients without lateral meniscus tears (4.4%; 2/45) (p=0.01). Patients with lateral meniscus tear were 5.04 [95%CI: 1.2 to 21.2] times more likely to develop OA. Thirteen of the 47 (28%) patients that underwent partial lateral meniscectomy developed lateral OA compared to 0% of patients (0/10) that underwent lateral meniscal repair (p=0.068). Conclusion: While studies with multiple surgeons and rehabilitation protocols have shown the development of OA following ACLR is increased with medial meniscal pathology, we found that the prevalence of medial OA was not significantly higher in these patients with medial meniscal tear at an average of 8.81 years follow-up. Whereas, lateral meniscal repair dramatically reduced the development of knee OA compared to partial meniscectomy in this cohort of patients with ACLR. These findings can inform clinical practice as despite prior literature indicating a relationship between medial meniscal tear and osteoarthritis, we did not see a greater prevalence of OA amongst patients undergoing ACLR with a medial meniscal tear. Further, a lateral meniscal repair offers superior protection against OA when compared to partial lateral meniscectomy in treating lateral meniscal tears and is essential in the treatment of these complex patients.

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