Dallas M Smuin1, Richard D Swenson2, Aman Dhawan3. 1. Penn State College of Medicine, Hershey, Pennsylvania, U.S.A. 2. Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, Pennsylvania, U.S.A. 3. Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Penn State Hershey Bone and Joint Institute, Hershey, Pennsylvania, U.S.A.. Electronic address: sportsandshoulderdoc@gmail.com.
Abstract
PURPOSE: To evaluate the surgical outcomes of symptomatic discoid menisci after total meniscectomy, saucerization, and suture repair of tears of a discoid meniscus at short- and long-term follow-up. METHODS: A systematic review was conducted using the Pubmed and ScienceDirect databases in adherence with Preferred Reporting Items of Systematic Reviews and Meta-Analysis guidelines. Short- and long-term follow-up were defined as an average follow-up of <4 years and >4 years, respectively. Pooled quantitative synthesis was performed on studies that reported results of total meniscectomy and saucerization in the same study. A systematic review was performed on studies that reported data on saucerization, total meniscectomy, and/or repair. RESULTS: A total of 19 studies for the short term and 22 for the long term were identified that met inclusion criteria for qualitative review. Of these, 4 short-term and 5 long-term studies were included in the quantitative synthesis. No significant differences in Ikeuchi scores are seen in the short-term studies between saucerization and total meniscectomy; however, the long-term studies did find a statistical difference favoring saucerization (P < .001). The differences noted between the preoperative and postoperative Lysholm scores in the short term were 24.1 (95% conflict of interest: 10.25-37.95) in 3 studies and 22.38 (95% conflict of interest: 17.68-27.07) in the 4 long-term studies for saucerization. Suture repair with saucerization versus saucerization without suture repair revealed a statistical difference in only 1 of 5 studies. CONCLUSIONS: Long-term data demonstrate significantly improved patient reported outcomes in favor of saucerization over total meniscectomy. Suture repair of tears of a lateral discoid meniscus does not demonstrate improved outcomes over partial meniscectomy without repair. Considering the cost of repair and lack of demonstrated improvement, based on the limited available data, we do not recommend repair of the abnormal anatomy in a torn lateral discoid meniscus. LEVEL OF EVIDENCE: Level IV, systematic review.
PURPOSE: To evaluate the surgical outcomes of symptomatic discoid menisci after total meniscectomy, saucerization, and suture repair of tears of a discoid meniscus at short- and long-term follow-up. METHODS: A systematic review was conducted using the Pubmed and ScienceDirect databases in adherence with Preferred Reporting Items of Systematic Reviews and Meta-Analysis guidelines. Short- and long-term follow-up were defined as an average follow-up of <4 years and >4 years, respectively. Pooled quantitative synthesis was performed on studies that reported results of total meniscectomy and saucerization in the same study. A systematic review was performed on studies that reported data on saucerization, total meniscectomy, and/or repair. RESULTS: A total of 19 studies for the short term and 22 for the long term were identified that met inclusion criteria for qualitative review. Of these, 4 short-term and 5 long-term studies were included in the quantitative synthesis. No significant differences in Ikeuchi scores are seen in the short-term studies between saucerization and total meniscectomy; however, the long-term studies did find a statistical difference favoring saucerization (P < .001). The differences noted between the preoperative and postoperative Lysholm scores in the short term were 24.1 (95% conflict of interest: 10.25-37.95) in 3 studies and 22.38 (95% conflict of interest: 17.68-27.07) in the 4 long-term studies for saucerization. Suture repair with saucerization versus saucerization without suture repair revealed a statistical difference in only 1 of 5 studies. CONCLUSIONS: Long-term data demonstrate significantly improved patient reported outcomes in favor of saucerization over total meniscectomy. Suture repair of tears of a lateral discoid meniscus does not demonstrate improved outcomes over partial meniscectomy without repair. Considering the cost of repair and lack of demonstrated improvement, based on the limited available data, we do not recommend repair of the abnormal anatomy in a torn lateral discoid meniscus. LEVEL OF EVIDENCE: Level IV, systematic review.
Authors: Orlando D Sabbag; Mario Hevesi; Thomas L Sanders; Christopher L Camp; Diane L Dahm; Bruce A Levy; Michael J Stuart; Aaron J Krych Journal: Orthop J Sports Med Date: 2018-09-24
Authors: Orlando D Sabbag; Mario Hevesi; Thomas L Sanders; Christopher L Camp; Diane L Dahm; Bruce A Levy; Michael J Stuart; Aaron J Krych Journal: Orthop J Sports Med Date: 2019-07-19