Abstract
Background:
A rare pattern associated with discoid lateral meniscus (DLM) is severe, degenerative tearing of posterolateral tissue, which may be mistaken on MRI for a bucket-handle lateral meniscus tear, rather than mildly anteriorly displaced complete discoid tissue and meniscal deficiency at the critical posterior horn-body junction. In this clinical setting, one of the few viable alternatives to subtotal meniscectomy is a novel technique of transfering the intact anteromedial tissue posterolaterally with meniscocapsular repair. The natural history and clinical outcomes of this ‘meniscoplasty’, or ‘discoid meniscus reconstruction (DLMR)’ have not been well investigated.
Objectives:
The study hypothesis was that the majority of DLMR patients would be able to return to sports without recurrent symptoms or meniscal re-tear, despite young age and high activity levels.
Methods:
This retrospective case series of patients <21 years-old who underwent ‘meniscoplasty’ or ‘meniscus reconstruction’ for DLM with severe, degenerative posterolateral tears or meniscal deficiency at the study institution from 1/1/15 to 10/1/24, with minimum of 9 months of clinical follow-up. Details of clinical presentation, MRI/diagnostic arthroscopy findings, surgical details, and clinical outcomes were analyzed, following a comprehensive medical record review.
Results:
14 patients (mean age, 11.3 years; range, 5-20 years), 11 (79%) of whom were females, met study criteria. Concomitant surgeries were performed in 4 patients (29%), including arthroscopic drilling of a lateral femoral condyle (LFC) osteochondritis dissecans (OCD) in 2 patients (21%) and implant-mediated guided-growth procedures (IM-GG) for ipsilateral genu valgum in 2 patients (14%). Mean duration of post-operative follow-up was 13.6 months (range: 9-41 months). Substantial radiographic healing was achieved for both LFC-OCD patients within 6 months and malalignment correction of was achieved for both IM-GG patients, with expected subsequent implant removal surgery for 1 patient, and achievement of skeletal maturity, with no implant-related symptoms, for the other. Two (14%) patients underwent unexpected revision meniscus surgeries in the form of partial meniscectomies, but no sub-total or total meniscectomy or meniscus transplant. All patients returned to their prior activity level and/or sports (RTS) at a mean of 6.1 months.
Conclusion:
I Severe degenerative tearing of a DLM is a rare presentation in children, but has relatively higher associations with genu valgum and LFC OCD than seen in the larger DLM population. Discoid meniscus reconstruction, a novel technique of meniscal tissue reconfiguration, transfer, and repair, showed favorable short-term results, with high rate of RTS low rates (14%) of revision meniscus surgery in the current series.