Discoid Meniscus Treatment & Management

Updated: Sep 27, 2021
  • Author: Ralph DiLibero, MD; Chief Editor: Thomas M DeBerardino, MD  more...
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Treatment

Approach Considerations

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. [24, 25]

An otherwise asymptomatic knee with the incidental finding of discoid meniscus is a contraindication for surgical treatment.

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Surgical Therapy

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. [26, 27]  (See the images below.) Current treatment approaches tend to focus on rim preservation with arthroscopic saucerization and meniscal repair for instability (if warranted). [28]

Arthroscopic appearance of complete discoid latera Arthroscopic appearance of complete discoid lateral meniscus. Probe is showing medial extent of lateral meniscus, which completely covers lateral tibial plateau. Image courtesy of Robert D Bronstein, MD.
Arthroscopic photograph following saucerization of Arthroscopic photograph following saucerization of discoid lateral meniscus. Edge of horizontal tear that traversed meniscus can be observed. Image courtesy of Robert D Bronstein, MD.

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 enable removal of the entire meniscus. [29]

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. [30, 31]

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. [32]

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Complications

Possible complications include the following:

  • Bleeding from a branch of the 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

Repeat surgical treatment may be necessary. In a study that included 379 knees with symptomatic discoid lateral meniscus treated with saucerization (partial meniscectomy) with or without meniscal repair or stabilization and followed up clinically, Logan et al found that 66 (17%) required reoperation at a median of 19.6 months (range, 9.2-34.9 mo) after surgery. [33]

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