Unstable Type III Wrisberg-type Lateral Discoid Meniscus: All-inside Arthroscopic Repair

Background: The Type III Wrisberg-type represents the rarest subtype of discoid meniscus. It exhibits a normal non-discoid “C”-shape with possible posterior horn hypertrophy, but meniscotibial ligaments and capsular restraints are lacking, leading to a clinical scenario of knee pain, popping, and catching due to meniscal hypermobility. Moreover, concomitant tears can be present due to repeated meniscal traumas. Indications: Type III Wrisberg-type lateral discoid meniscus with hypermobility, dislocation, or tear. Technique Description: Through standard arthroscopic portals, the meniscus is reduced in its anatomical position (if displaced). Abnormal mobility and anatomy should be noted. All-inside sutures are used in the posterior horn and body to stabilize the meniscus to the capsule and popliteus tendon. In the case of radial tears, horizontal stitches are used. Results: Patients are expected to return to sport approximately 4 to 5 months after the procedure with relief of pain, popping sensation, and knee locking. Conclusion: Arthroscopic all-inside repair is an effective treatment for unstable and displaced Type III Wrisberg-type lateral discoid meniscus. However, the diagnosis can be challenging, especially without frank meniscal dislocation.

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Is the present classification of discoid meniscus sufficient?

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117s00049 ◽

2017 ◽

Vol 5 (2_suppl2) ◽

pp. 2325967117S0004

Author(s):

Hasan Bombaci ◽

Fatma Gökel ◽

Emrah Geçgel ◽

Suavi Aydoğmuş

Keyword(s):

Lateral Meniscus ◽

Partial Meniscectomy ◽

Posterior Horn ◽

Anterior Horn ◽

Meniscus Tear ◽

Discoid Lateral Meniscus ◽

Popliteus Tendon ◽

Discoid Meniscus ◽

The Stability

Introduction: Although uncommon, the discoid meniscus is quite prone to injury due to its abnormal shape and abnormal histology. The weak or absent peripheral attachment of the discoid meniscus causes instability even after partial meniscectomy. Therefore, recently, after resection of the central part of the meniscus, in which tears develop most frequently, the remnant of the meniscus is preferred to repair. In that time, the Watanabe classification, which classifies the discoid meniscuses in three groups, is used to plan treatment. However, discoid meniscus can develop in the different forms from these three main shapes. In the present study we aimed to analyse the discoid meniscuses, which we encountered during arthroscopic procedures in the knee, according to Watanabe classification. Patients and methods: The lateral discoid meniscuses in the 36 knees of 35 patients, who were operated on because of meniscus tear of either the discoid lateral meniscus itself or the normal medial meniscus, were classified according to Watanabe classification. Results: While the lateral discoid meniscuses were classified as “complete” in 13, “incomplete” in 15 knees, the meniscuses were very thin or absent in the central (one knee) or in the postero-lateral regions (seven knees) of discoid meniscus ( Figure 1 ). In this series this opening was next to the popliteus tendon except in one case. In these cases, the continuity of the meniscus between middle and posterior horn frequently was not possible after central partial meniscectomy (CPM). On the other hand, posterior horn has stable peripheral attachment unlike the Wrisberg type discoid meniscus. Of the 36 discoid meniscuses, CPM was performed in 21 knees, CPM with anterior horn repair in three, CPM with posterior horn repair in one and anterior horn repair without meniscectomy in two patients. In nine patients the lateral discoid meniscus was left alone. [Figure: see text] Discussion and conclusion: When meniscus sparing methods are intended to perform, both to decide the amount of resection and repair of the remnant, besides the shape of meniscus tear, the stability of discoid meniscus is crucial. This study shows that the Watanabe classification cannot be sufficient to include some specific type of lateral discoid meniscus. We believe that to add the discoid meniscuses, with opening in postero-lateral region next to the popliteus tendon, to the Watanabe classification might be useful to decide the amount of resection or repair of the discoid lateral meniscus.

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Keto-Sleuths – An Unusual Cause of Loss of Ketosis?

Child Neurology Open ◽

10.1177/2329048x211029736 ◽

2021 ◽

Vol 8 ◽

pp. 2329048X2110297

Author(s):

Christine M. Foley ◽

Christopher Ryan ◽

Stacey Tarrant ◽

Ann M. Bergin

Keyword(s):

Effective Treatment ◽

Seizure Control ◽

Refractory Epilepsy ◽

Clinical Scenario ◽

Diet Restriction ◽

Ketogenic Diets ◽

Control And Prevention

Ketogenic diets provide a non-pharmaceutical alternative for treatment of refractory epilepsy. When successful in reducing or eliminating seizures, medication numbers or doses may be reduced. Unexpected loss of ketosis is a common problem in management of patients on ketogenic diets and, especially when the diet is an effective treatment, loss of ketosis may be associated with an exacerbation in seizures. Identification of the cause of loss of ketosis is critical to allow rapid resumption of seizure control, and prevention of unnecessarily increased diet restriction or increased medication doses. Here an unusual environmental cause of loss of ketosis is described (contamination with starch-containing drywall dust), illustrating the extent of investigation sometimes necessary to understand the clinical scenario.

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The Popliteus Tendon Provides a Safe and Reliable Location for Anchor Placement in Posterior Horn Lateral Meniscal Repairs

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2018.10.041 ◽

2018 ◽

Vol 34 (12) ◽

pp. e11

Author(s):

Adnan Saithna ◽

Hervé Ouanezar ◽

William G. Blakeney ◽

Charles Latrobe ◽

Levi Reina Fernandes ◽

...

Keyword(s):

Posterior Horn ◽

Popliteus Tendon

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DEFINING A SAFE ZONE FOR ALL INSIDE LATERAL MENISCUS REPAIRS IN PEDIATRIC PATIENTS: A MAGNETIC RESONANCE IMAGING STUDY

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00170 ◽

2019 ◽

Vol 7 (3_suppl) ◽

pp. 2325967119S0017

Author(s):

Jennifer Beck ◽

Kendall Shifflett ◽

Danielle Greg ◽

Edward Ebramzadeh ◽

Richard E. Bowen

Keyword(s):

Pediatric Patients ◽

Age Groups ◽

Lateral Meniscus ◽

Safe Zone ◽

Neurovascular Bundle ◽

Posterior Horn ◽

Popliteus Tendon ◽

Anterior Edge ◽

Group I ◽

Significant Difference

Purpose All-inside posterior horn lateral meniscal (PHLM) repair puts the popliteal neurovascular bundle (PVNB) at risk of injury by meniscal repair devices. The purpose of this study was to establish a safe zone of all-inside meniscal fixation in pediatric patients using MRI measurements between the popliteus tendon (PT) and popliteal neurovascular bundle (PNVB). We hypothesize that males and older age groups will have a larger distance between PT and PNVB. Methods Axial MRIs of 250 pediatric (5-16 yrs.) patients were retrospectively reviewed. Patients were grouped by age: group I (5-7yrs.): 61; II (8-10yrs.): 59; III (11-13yrs.): 60; IV (14-16yrs.): 70. At the level of the lateral meniscus, two lines starting at the lateral patella tendon border ending at the medial edge of the PT (D1) and the lateral edge of the PNVB (D2) were made on an axial knee MRI. D3 connected D1 to D2 at the meniscocapsular junction of the PHLM. D4 was derived geometrically, parallel and 8 mm anterior to D3 simulating the anterior edge of the PHLM. Results Analysis showed significant correlation between age and sex for D3 (p<0.0001). For D3, there were significant differences among all age groups, except between groups III and IV. Average (STD) D3 for age groups was: 14.1mm(3.1), 15.8(2.5), 17.0(3.3), 17.2(3.1). For D4, the average (STD) was: 11.9 mm(2.9); 13.9(2.5); 15.4(3.0); 15.2(2.9). There was significant difference in D3 and D4 in males versus females (17.6 vs 15.7 mm; p <0.001; 14.9 vs 13.2; p <0.001), particularly in III and IV (17.0 vs 13.8 and 16.8 vs 13.9). Conclusions This study provides normative data of the distance between popliteal neurovascular bundle and popliteus tendon at the meniscocapsular junction (D3) and anterior edge of the posterior horn lateral meniscus (D4) with the knee in full extension. Combined with previous studies showing the addition of knee flexion increases the distance between the meniscus and the neurovascular bundle, surgeons can use this data to improve safety of posterior horn lateral meniscus repair in pediatric patients.

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Arthroscopic repair for a flap tear of the posterior horn of the lateral meniscus adjacent to its tibial insertion

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/0749-8063(95)90207-4 ◽

1995 ◽

Vol 11 (4) ◽

pp. 495-498 ◽

Cited By ~ 23

Author(s):

Konsei Shino ◽

Masayuki Hamada ◽

Tomoki Mitsuoka ◽

Hiroaki Kinoshita ◽

Yukiyoshi Toritsuka

Keyword(s):

Lateral Meniscus ◽

Posterior Horn ◽

Arthroscopic Repair ◽

Tibial Insertion ◽

Flap Tear

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Return to Sport Following Arthroscopic Repair of Anterior, Posterior, and Combined Shoulder Instability

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2017.08.043 ◽

2017 ◽

Vol 33 (10) ◽

pp. e62-e63

Author(s):

Eric C. McCarty ◽

Matthew J. Kraeutler ◽

Nicholas Aberle ◽

John B. Schrock ◽

Colin C. Brown ◽

...

Keyword(s):

Shoulder Instability ◽

Return To Sport ◽

Arthroscopic Repair ◽

Anterior Posterior

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An 11-Year-Old Girl Presenting with Chronic Knee Pain: A Case Report with Diagnostic Dilemma

Acta Medica (Hradec Kralove Czech Republic) ◽

10.14712/18059694.2016.86 ◽

2010 ◽

Vol 53 (4) ◽

pp. 247-249

Author(s):

Muhammad Kamal Maj ◽

Abdul Halim Ar ◽

Syed A. Faisal ◽

Johan Ahmad ◽

Srijit Das

Keyword(s):

Lateral Meniscus ◽

Knee Extension ◽

Posterior Horn ◽

Discoid Meniscus ◽

Diagnostic Challenge ◽

Diagnostic Dilemma ◽

Chronic Knee Pain ◽

Sport Activities ◽

Partial Deficiency ◽

Joint Line Tenderness

Discoid meniscus is the commonest anatomical aberration of the knee joint, among rare cases such as bilateral separated lateral meniscus, accessory lateral meniscus, partial deficiency of the lateral meniscus and double-layered lateral meniscus. An 11-year- old girl presented with history of chronic pain in her right knee for the last 6 months. The problem disturbed her involvement in the sport activities at school. Clinical examination revealed a clicking sensation on knee extension with lateral joint line tenderness. Magnetic resonance imaging (MRI) of her right knee showed torn posterior horn of lateral meniscus. Arthroscopy examination revealed a discoid meniscus with absence posterior horn. Posterior horn deficient discoid meniscus is a rare form of a congenital meniscus anomaly. We as clinicians believe that the abnormal shaped meniscus may pose a diagnostic challenge clinically and radiologically. Presentation of this case may be beneficial for orthopaedicians in their daily clinical practice.

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