Discoid Meniscus Treatment & Management
- Author: Ralph DiLibero, MD; Chief Editor: Thomas M DeBerardino, MD more...
Abnormalities of knee function, pain, and effusion are indications for surgical treatment. Surgical treatment varies according to the type of lateral discoid meniscus present. Arthroscopic procedures are quite successful and are somewhat more technically demanding than are routine meniscal tear excisions because of the younger age, the tighter joints, and reduced room available to manipulate arthroscopic equipment.[15, 16]
An otherwise asymptomatic knee with the incidental finding of discoid meniscus is a contraindication for surgical treatment.
Surgical techniques for treatment of discoid menisci range from sculpting and partial meniscectomy to complete removal, starting with removal of the anterior portion for better arthroscopic visualization.[17, 18] (See the images below.)
Arthroscopic removal of a torn, normally configured lateral meniscus, in its entirety, is accomplished by first releasing the anterior horn, then releasing the attachment to the popliteal tendon, and then partially releasing the posterior horn. Finally, the meniscus is displaced into the intercondylar notch to complete the posterior release and remove the entire meniscus.
A discoid lateral meniscus often has a continuous attachment from the popliteal tendon to the posterior horn. Removal of the anterior horn is necessary; the remainder of the discoid meniscus is then removed in a piecemeal fashion. An arthroscopic Bovie or other type of coagulation system should be available to stop possible bleeding from a branch of the lateral geniculate artery.
Because of the hypermobility of the entire meniscus in the Wrisberg (type III) deformity, sculpting the meniscus is ineffective, and better results have been reported with a near-complete to complete meniscectomy. Some attempts have been made to avoid total meniscectomy by tying down the meniscus through drill holes in the tibia to correct the anatomic defect.[20, 21]
In terms of the Watanabe classification, the indicated treatment for tears of discoid meniscus type I (complete), type II (incomplete), and the central-holed or ring-shaped version is removal of the central discoid and ring portions, including any areas of tearing, followed by arthroscopic sculpting of the remaining meniscus.
Ahn et al evaluated the long-term clinical and radiographic results of arthroscopic reshaping, with or without peripheral meniscus repair, in 38 children (48 knees; mean age, 9.9 years) with symptomatic discoid lateral meniscus. The surgical procedure performed was arthroscopic partial meniscectomy alone (22 knees), partial meniscectomy with repair (18 knees), or subtotal meniscectomy (8 knees). At a mean follow-up of 10.1 years, progression of degenerative changes was significantly greater in the group treated with subtotal meniscectomy than in either of the partial meniscectomy groups.
Possible complications include the following:
Bleeding from a branch of lateral geniculate artery
Damage to the articular surface of the joint
Incomplete removal of the tear
Rigid high border in unsculpted removal, resulting in further tearing
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