Abstract
Objectives:
Discoid meniscus (DM) repair is the gold standard treatment for unstable DM. Good early clinical outcomes have been reported following DM repair, however, it is unclear if these outcomes can be sustained over time due to the dearth of long-term studies. The purpose of this study is to report the clinical outcomes following DM repair with a minimum of 5 years of follow-up.
Methods:
This is a retrospective review of patients under 21 years old who underwent arthroscopic treatment for DM from 2014 to 2023 with a minimum of 5-year follow-up. Patients with stable DM underwent saucerization, and those with unstable DM had saucerization with meniscal repair. Data collection included demographics, clinical presentation, meniscal pathology, surgical technique, re-operation and complication rates. Patient reported outcome (PRO) scores were collected post-operatively starting at the 1- year follow-up. Patients were called at final follow-up to confirm their function level. Wilcoxon rank-sum tests compared the PRO scores between the stable and unstable meniscus groups.
Results:
There were 39 patients who underwent surgical management at a mean age 13.13 ± 3.75 years with a median follow-up time of 6.66 years (IQR 4.96 – 7.98). Of these, 18 (46.1%) had stable and 21 (53.9%) had unstable DM. Patients that presented with unstable DM were younger (12.2 vs 14.1, p< 0.001) and had fewer chondral lesions (0 vs 4, p=0.04). Of the 39 patients called at final follow-up, 38 responded (97.4%) and 36 (92.3%) reported their knee function had returned to pre-injury level. Among the four patients who experienced complications following their initial surgeries, three underwent a second surgical intervention (Table 1). Subgroup analysis at a median 7.36 years from surgery demonstrated significantly better PROs for the repair group compared to the non-repair group as seen on Tengner Lysholm (99.0 vs 85.5, p=0.02), Pedi-IKDC (98.3 vs 88.5, p< 0.01), KOOS Child Symptom (100 vs 87.8, p< 0.01), and KOOS Child ADL (100 vs 99.0, p=0.04) PROs (Table 2).
Conclusions:
The majority (95%) of patients returned to their pre-injury function level at a minimum of 5 years of follow-up from DM surgery and at an average of 7 years post-operatively. Long term subgroup analysis demonstrated better PROs in the DM repair group compared with non-repair group. Our findings support DM preservation surgery as an effective and safe technique that leads to sustainable long-term clinical outcomes.
