Benjamin Johnson1, Catriona Heaver2, Robin Gilbert2, Andrew Roberts2. 1. Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, SY10 7AG, UK. bjohnso25@yahoo.co.uk. 2. Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, SY10 7AG, UK.
Abstract
PURPOSE: Symptomatic discoid lateral meniscus without tears has traditionally been treated with excision of part or the entire meniscus. Resection of 15-34% of the meniscus increases tibiofemoral contact pressures by more than 350%. Treatment of discoid lateral meniscus with partial or total meniscectomy in childhood increases the risk of early-onset osteoarthritis in the knee. The incidence of osteoarthritis is directly proportional to the amount of meniscal tissue resected. This paper describes the meniscus-preserving technique of meniscopexy and presents the outcomes of all patients who have undergone this procedure in the management of lateral discoid meniscus in a single unit over a 14-year period. METHODS: A retrospective study was carried out reviewing all patients who underwent meniscopexy for the treatment of MRI-confirmed discoid lateral meniscus without meniscal tear between 2001 and 2015 with a minimum of 1-year follow-up. Eleven patients (12 knees) were identified using a patient database of all patients that had undergone this procedure in our institution. Two patients were excluded from the final results, so nine patients (10 knees) were scored post-operatively at last follow-up using the Lysholm knee score. We reviewed all available post-operative MRI scans and recorded any complications. RESULTS: Four patients were male and seven were female. The median age of the patients at the time of surgery was 9 (6-14), and the median follow-up was 4.5 years (2-14). The median Lysholm knee score was 91 (86-100). The outcome for all patients scored was either good or excellent. CONCLUSION: The established treatment options for symptomatic discoid lateral meniscus without associated tear involve resection of meniscal tissue. Using this technique, all the meniscal tissue is preserved, thus reducing the risk of arthritic change in the future. MRI studies performed post-operatively suggested normalisation of meniscal morphology with time. Meniscopexy offers an effective alternative to the established treatment options in the management of symptomatic discoid lateral meniscus without meniscal tears. LEVEL OF EVIDENCE: IV.
PURPOSE: Symptomatic discoid lateral meniscus without tears has traditionally been treated with excision of part or the entire meniscus. Resection of 15-34% of the meniscus increases tibiofemoral contact pressures by more than 350%. Treatment of discoid lateral meniscus with partial or total meniscectomy in childhood increases the risk of early-onset osteoarthritis in the knee. The incidence of osteoarthritis is directly proportional to the amount of meniscal tissue resected. This paper describes the meniscus-preserving technique of meniscopexy and presents the outcomes of all patients who have undergone this procedure in the management of lateral discoid meniscus in a single unit over a 14-year period. METHODS: A retrospective study was carried out reviewing all patients who underwent meniscopexy for the treatment of MRI-confirmed discoid lateral meniscus without meniscal tear between 2001 and 2015 with a minimum of 1-year follow-up. Eleven patients (12 knees) were identified using a patient database of all patients that had undergone this procedure in our institution. Two patients were excluded from the final results, so nine patients (10 knees) were scored post-operatively at last follow-up using the Lysholm knee score. We reviewed all available post-operative MRI scans and recorded any complications. RESULTS: Four patients were male and seven were female. The median age of the patients at the time of surgery was 9 (6-14), and the median follow-up was 4.5 years (2-14). The median Lysholm knee score was 91 (86-100). The outcome for all patients scored was either good or excellent. CONCLUSION: The established treatment options for symptomatic discoid lateral meniscus without associated tear involve resection of meniscal tissue. Using this technique, all the meniscal tissue is preserved, thus reducing the risk of arthritic change in the future. MRI studies performed post-operatively suggested normalisation of meniscal morphology with time. Meniscopexy offers an effective alternative to the established treatment options in the management of symptomatic discoid lateral meniscus without meniscal tears. LEVEL OF EVIDENCE: IV.