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