Abstract
BACKGROUND
There has been an increase in the understanding of meniscus tears in pediatric and adolescent patients particularly with the rise of intensive sport training in this age group. Yet, discoid menisci represent a congenital entity for which there exists controversy as to the optimal workup, treatment, and long-term outcomes. Although there have been multiple reports on the surgical treatment of these patients, there is limited examination of these patient’s demographic characteristics and presentation. The purpose of this study is to define the demographics, presentation, and treatment patterns of discoid menisci in a single surgeon’s patient cohort
METHODS
We performed a retrospective review of all discoid meniscus patients from a single institution from 2012 to 2017. Demographics, history and physical examination notes, and intra-operative findings were reviewed.
RESULTS
Eighty-one patients were identified. Patients identifying as Hispanic (38%) and Caucasian (23%) made up the most common ethnic group. The average age at the time of presentation was 12.5 years old. Ninety-eight percent of patients reported pain upon presentation; however, this was commonly in conjunction with other symptoms. Most patients (48%) reported only short duration of symptoms (0 to 3 months) prior to presentation. In about one half of patients, tears were identified in 44 (54%) patients, and nearly 2/3 of patients (52) elected to undergo surgical intervention. Patients undergoing operative intervention had a high proportion of range of motion deficits (69% v 17%, p<0.001), meniscal tears (77% v 17%, p<0.001) and cartilage damage (33% v 3%, p=0.002). Nearly 2/3 of patients who required intervention necessitate meniscal repair with or without concomitant cartilage procedures.
CONCLUSIONS / SIGNIFICANCE
Unlike prior studies, the vast majority of patients with discoid menisci in our population were Hispanic or Caucasian. Although congenital, the vast majority of patients presented with a short duration of complaints (less than 6 months) in the second decade of life. A complex constellation of symptoms was present with isolated knee pain seen less commonly as well as athletic participation. Loss of range of motion drives surgical intervention with meniscal repair being more commonly performed regardless of symptom duration as opposed to saucerization. Nearly 1/3 of patients demonstrated cartilage damage intra-operatively; demonstrating the need for surgeons to not only counsel patients pre-operatively but also be prepared to repair and/or treat cartilage rather than perform saucerization.