DISCOID MENISCUS

Iwan Hipsa

INTRODUCTION
Meniscus
Cartilage structure in the knee.
Two menisci, an inner and an outer meniscus.

- Distribute the forces between the two

bones over a greater area (rather than
point to point),
- Supply nutrition to the cartilage), and
- Stabilize the knee.

INTRODUCTION

A discoid meniscus is a congenital

(born with) variant of the normal
meniscus
First described in the late 1800s.
More oval or disk shaped High
incidence of mechanical
deformation Prone to injury
The meniscus may cause
symptoms without injury or can
cause symptoms when torn or
injured.

ETIOLOGY
The cause is unkown
Is thought to be a developmental or congenital problem.
Results from a developmental anomaly before birth.
After birth, no sudden change occurs in meniscal development. 1

1. Klingele KE, Kocher MS, Hresko MT. Discoid lateral meniscus: prevalence of peripheral rim instability. J Pediatr Orthop. 2004 Jan-Feb. 24(1):79-82

EPIDEMIOLOGY

Discoid lateral menisci 3-5% in the general population.

Discoid medial menisci 0.1-0.3%.

The Asian population has a slightly higher rate of occurrence.

Location usually lateral meniscus involved and 25% occur bilateral.2

2. Ryu KN, Kim IS, Kim EJ, et al. MR imaging of tears of discoid lateral menisci. AJR Am J Roentgenol. 1998 Oct. 171(4):963-7.

SIGN AND SYMTOMPS

The most common symptoms of a discoid meniscus or torn discoid
meniscus are3:
Pain
Stiffness or swelling
Catching, popping, locking of the knee
Feeling that the knee is "giving way"
Inability to fully extend (straighten) the knee

3. The American Academy of Orthopaedic Surgeons. Discoid Meniscus. AAOS. 2010 Nov.

CLASSIFICATION

Watanabe Calssification :
I. Incomplete.
II. Complete.
III. Hypermobile Wrisberg. This occurs when the meniscofemoral ligament that
attaches the meniscus to the tibia is absent. Without this ligament, even a
fairly normally shaped meniscus can sometimes slip into the joint and cause
pain, as well as locking and popping of the knee.

IMAGING
Radiography
Widening of the lateral joint clear space and cupping.
Cupping is a reversal of the normally flat to convex
bony shape of the lateral tibial plateau into a more
concave shape.
There is Hypoplastic lateral intercondylar spine

IMAGING
MRI
MRI is the modality of choice to evaluate a discoid meniscus before surgery.
The most common diagnostic finding is that of a "bow-tie" sign (3 or more
5mm sagittal images with meniscal continuity) 6

6. Monllau JC, Leon A, Cugat R, Ballester J. Ring-shaped lateral meniscus. Arthroscopy. 1998 Jul-Aug. 14(5):502-4.

MANAGEMENT
NON-OPERATIVE
Indication is asymptomatic discoid meniscus without tears.
Performed only observation.
OPERATIVE
Partial meniscectomy and saucerization

MANAGEMENT
Partial meniscectomy and saucerization 7
Indications : pain and mechanical symptoms, meniscal tear or meniscal
detachment.
Watanabe classification, the indicated treatment type I (complete), type II
(incomplete), and the central-holed or ring-shaped
removal of the central discoid and ring portions, including any areas of
tearing, followed by arthroscopic sculpting of the remaining meniscus

7. Araki Y, Ashikaga R, Fujii K, et al. MR imaging of meniscal tears with discoid lateral meniscus. Eur J Radiol. 1998 May. 27(2):153-60.

MANAGEMENT
The hypermobility of the entire meniscus - Wrisberg (type III) deformity
sculpbetter results have been reported with a near-complete to
complete meniscectomy.8

8. Good CR, Green DW, Griffith MH, Valen AW, Widmann RF, Rodeo SA. Arthroscopic treatment of symptomatic discoid meniscus in children:
classification, technique, and results. Arthroscopy. 2007 Feb. 23(2):157-63.

MANAGEMENT
Vertical tear of the discoid lateral meniscus (A),
The torn discoid lateral meniscus demonstrating
displacement of the tear (B).
Final appearance of the lateral meniscus
following resection of the tear and contouring of
the remaining meniscus (C)

MANAGEMENT

Radial tear meniscus and after saucerization with

posterior meniscus repair

MANAGEMENT
Post operatif
Initiation of a home exercise program and formal physical therapy (PT)
should begin within 12 days of surgery. Weight bearing is permitted as
tolerated.5

MANAGEMENT
Weeks 03
PT two to three times per week
Focus on full extension (hyperextension symmetrical to contralateral
knee)
Quad sets and straight leg raises
Patella mobilization
Prone knee flexion, heel slides, calf and hamstring stretching
Cryotherapy
Crutches are discontinued once the patient achieves full extension
and ambulates without a limp
Begin quadriceps and hamstring strengthening exercises.

MANAGEMENT
Weeks 36
PT two to three times per week
Focus rehabilitation toward closed-chain exercises.
Endurance exercises
Slow jogging and running may be initiated.
Weeks 612
Home program three to five times per week
Advanced strengthening exercises
Begin functional training exercisesfast running, cutting, crossovers.

MANAGEMENT
Full return to sports
Normal muscle strength
Can run full speed without a limp
Full range of motion

COMPLICATION
Possible complications include the following:
Bleeding from a branch of lateral geniculate artery
Damage to the articular surface of the joint
Incomplete removal of the tear
Rigid high border in unsculpted removal, resulting in further tearing
Postoperative hemarthrosis
Phlebitis

OUTCOME
Aichroth and associates reported 37% excellent, 47% good and 16% fair results
at an average follow-up of 5.5 years, in a study of 52 children treated at an average
age of 10.5 years with arthroscopic partial meniscal resection.
Pellacci and colleagues reported excellent or good outcomes in 17 of 18 knees
after partial resection of discoid meniscus.
Bellier and colleagues reported excellent results in 18 of 19 children treated
with partial discoid meniscectomy at an average follow-up of 3 years

Aichroth PM, Patel D, Marx C. Congenital discoid lateral meniscus in children: a follow-up study and evolution of management. J Bone Joint Surg
Br 1991;73:932-6.
Pellacci F, Montanari G, Prosperi P, Galli G, Celli V. Lateral discoid meniscus: treatment and results. Arthroscopy 1992;8:526-30.
Bellier G, DuPont JY, Larrain M, Caudron C, Carlioz H. Lateral discoid menisci in children. Arthroscopy 1989;5:52-6.

THANK
YOU