Discoid Meniscus Treatment & Management

  • Author: Ralph DiLibero, MD; Chief Editor: Carlos J Lavernia, MD, FAAOS   more...
 
Updated: Jul 8, 2011
 

Surgical Therapy

Surgical treatment varies according to the type of lateral discoid meniscus. Arthroscopic procedures are quite successful and are somewhat more technically demanding than are routine meniscal tear excisions because of the younger age, tighter joints, and less room available to manipulate arthroscopic equipment.[16, 17] Surgical techniques vary, from sculpting and partial meniscectomy to complete removal, starting with removal of the anterior portion for better arthroscopic visualization.[18, 19]

See the images below.

Arthroscopic appearance of a complete discoid lateArthroscopic appearance of a complete discoid lateral meniscus. The probe is showing the medial extent of the lateral meniscus, which completely covers the lateral tibial plateau. Image courtesy of Robert D. Bronstein, MD. Arthroscopic photograph following saucerization ofArthroscopic photograph following saucerization of a discoid lateral meniscus. The edge of a horizontal tear that traversed the meniscus can be observed. Image courtesy of Robert D. Bronstein, MD.

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]

Using 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.[22]

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Preoperative Details

The preoperative and postoperative management of a torn discoid meniscus is the same as that for a torn lateral meniscus with a normal anatomy.

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Complications

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
  • Postoperative hemarthrosis
  • Phlebitis
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Contributor Information and Disclosures
Author

Ralph DiLibero, MD  Acting Chief, Policy Section, California Medi-Cal

Ralph DiLibero, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, California Orthopedic Association, and Los Angeles County Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Phillip J Marone, MD, MSPH  Clinical Professor, Department of Orthopedic Surgery, Jefferson Medical College

Phillip J Marone, MD, MSPH is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Medical Association, American Orthopaedic Society for Sports Medicine, and Philadelphia County Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Thomas M DeBerardino, MD  Associate Professor, Department of Orthopedic Surgery, Consulting Surgeon, Sports Medicine, Arthroscopy and Reconstruction of the Knee, Hip and Shoulder, Team Physician, Orthopedic Consultant to UConn Department of Athletics, University of Connecticut Health Center

Thomas M DeBerardino, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, and American Orthopaedic Society for Sports Medicine

Disclosure: Arthrex, Inc. Grant/research funds Other; Arthrex, Inc. Consulting fee Speaking and teaching; Genzyme Biosurgery. Inc. Grant/research funds Other; Musculoskeletal Transplant Foundation Grant/research funds Other; Histogenics Grant/research funds None

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Carlos J Lavernia, MD, FAAOS  Adjunct Clinical Professor, Department of Orthopedic Surgery, University of Miami School of Medicine; Medical Director, Orthopedic Institute at Mercy Hospital

Carlos J Lavernia, MD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Hip and Knee Surgeons, Arthritis Foundation, Biomedical Engineering Society, Florida Orthopaedic Society, and Orthopaedic Research Society

Disclosure: Zimmer Stock Implant Designer

References

  1. Lee BI, Min KD. Abnormal band of the lateral meniscus of the knee. Arthroscopy. Sep 2000;16(6):11. [Medline].

  2. Choi NH, Kim NM, Kim HJ. Medial and lateral discoid meniscus in the same knee. Arthroscopy. Feb 2001;17(2):E9. [Medline].

  3. Akgun I, Heybeli N, Bagatur E, et al. Bilateral discoid medial menisci: an adult patient with symmetrical radial tears in both knees. Arthroscopy. Jul-Aug 1998;14(5):512-7. [Medline].

  4. Ryu KN, Kim IS, Kim EJ, et al. MR imaging of tears of discoid lateral menisci. AJR Am J Roentgenol. Oct 1998;171(4):963-7. [Medline].

  5. Ikeuchi H. Arthroscopic treatment of the discoid lateral meniscus. Technique and long-term results. Clin Orthop. Jul 1982;(167):19-28. [Medline].

  6. Klingele KE, Kocher MS, Hresko MT. Discoid lateral meniscus: prevalence of peripheral rim instability. J Pediatr Orthop. Jan-Feb 2004;24(1):79-82. [Medline].

  7. Clark CR, Ogden JA. Development of the menisci of the human knee joint. Morphological changes and their potential role in childhood meniscal injury. J Bone Joint Surg Am. Apr 1983;65(4):538-47. [Medline].

  8. Kim EY, Choi SH, Ahn JH, Kwon JW. Atypically thick and high location of the Wrisberg ligament in patients with a complete lateral discoid meniscus. Skeletal Radiol. Sep 2008;37(9):827-33. [Medline].

  9. Fung DA, Frey S, Markbreiter L. Bilateral symptomatic snapping biceps femoris tendon due to fibular exostosis. J Knee Surg. Jan 2008;21(1):55-7. [Medline].

  10. Yoo WJ, Choi IH, Chung CY, Lee MC, Cho TJ, Park MS, et al. Discoid lateral meniscus in children: limited knee extension and meniscal instability in the posterior segment. J Pediatr Orthop. Jul-Aug 2008;28(5):544-8. [Medline].

  11. Hart ES, Kalra KP, Grottkau BE, Albright M, Shannon EG. Discoid lateral meniscus in children. Orthop Nurs. May-Jun 2008;27(3):174-9; quiz 180-1. [Medline].

  12. Krause FG, Haupt U, Ziebarth K, Slongo T. Mini-arthrotomy for lateral discoid menisci in children. J Pediatr Orthop. Mar 2009;29(2):130-6. [Medline].

  13. Yukawa T, Ochi M, Kobayashi T, Adachi N, Nakamura M, Yamada K. Magnetic force-assisted meniscal resection under arthroscopy. Knee Surg Sports Traumatol Arthrosc. Oct 2008;16(10):916-20. [Medline].

  14. Araki Y, Ashikaga R, Fujii K, et al. MR imaging of meniscal tears with discoid lateral meniscus. Eur J Radiol. May 1998;27(2):153-60. [Medline].

  15. Connolly B, Babyn PS, Wright JG, et al. Discoid meniscus in children: magnetic resonance imaging characteristics. Can Assoc Radiol J. Oct 1996;47(5):347-54. [Medline].

  16. Andrisani, Miller, Rubenstein. Surgical Management of Discoid Meniscus. Techniques in Knee Surgery. 2006;128-33.

  17. Good CR, Green DW, Griffith MH, Valen AW, Widmann RF, Rodeo SA. Arthroscopic treatment of symptomatic discoid meniscus in children: classification, technique, and results. Arthroscopy. Feb 2007;23(2):157-63. [Medline].

  18. Smith CF, Van Dyk GE, Jurgutis J, Vangsness CT Jr. Cautious surgery for discoid menisci. Am J Knee Surg. Winter 1999;12(1):25-8. [Medline].

  19. Ogata K. Arthroscopic technique: two-piece excision of discoid meniscus. Arthroscopy. Oct 1997;13(5):666-70. [Medline].

  20. Ahn JH, Lee SH, Yoo JC, Lee YS, Ha HC. Arthroscopic partial meniscectomy with repair of the peripheral tear for symptomatic discoid lateral meniscus in children: results of minimum 2 years of follow-up. Arthroscopy. Aug 2008;24(8):888-98. [Medline].

  21. Adachi N, Ochi M, Uchio Y. Torn discoid lateral meniscus treated using partial central meniscectomy and suture of the peripheral tear. Arthroscopy. May 2004;20(5):536-42. [Medline].

  22. Monllau JC, Leon A, Cugat R, Ballester J. Ring-shaped lateral meniscus. Arthroscopy. Jul-Aug 1998;14(5):502-4. [Medline].

 
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Radiograph of an 8-year-old child with bilateral discoid menisci, diagnosis confirmed by MRI. Patient is only symptomatic on the left side. Patient underwent arthroscopy and partial meniscectomy and is now asymptomatic. Image courtesy of Dennis P. Grogan, MD.
MRI scan of typical discoid meniscus. Image courtesy of William Morrison, MD.
MRI scan of typical discoid meniscus. Image courtesy of William Morrison, MD.
Coronal MRI scan demonstrating a complete discoid meniscus (arrow). Image courtesy of Robert D. Bronstein, MD.
Knee radiograph of a 17-year-old athlete with a discoid lateral meniscus. The lateral joint space is widened, and the tibial plateau has a flattened appearance. Image courtesy of Robert D. Bronstein, MD.
Arthroscopic appearance of a complete discoid lateral meniscus. The probe is showing the medial extent of the lateral meniscus, which completely covers the lateral tibial plateau. Image courtesy of Robert D. Bronstein, MD.
Arthroscopic photograph following saucerization of a discoid lateral meniscus. The edge of a horizontal tear that traversed the meniscus can be observed. Image courtesy of Robert D. Bronstein, MD.
 
 
 
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