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  • Title: [Long-Term Outcomes of Surgical Management of Symptomatic Fibular Discoid Meniscus in Childhood].
    Author: Jochymek J, Peterková T.
    Journal: Acta Chir Orthop Traumatol Cech; 2015; 82(5):353-7. PubMed ID: 26516954.
    Abstract:
    PURPOSE OF THE STUDY: The aim of the study was to evaluate the outcomes of treatment in patients operated on in childhood for discoid meniscus, and to compare the results with those published in the relevant international literature. MATERIAL AND METHODS: The group evaluated consisted of 15 patients, 10 girls and five boys, who underwent surgery for symptomatic discoid meniscus in the period from 2000 to 2010. The average age at the time of surgery was 9 years and 2 months. The diagnosis was based on the patient's history of complaints, physical examination, X-rays of the knee joint taken in two planes, and ultrasonographic and magnetic resonance imaging of the knee. Arthroscopic verification of the diagnosis was done in all patients. They all had fibular discoid meniscus classified as type 1 in six and type 2 in nine patients according to the Watanabe classification system. Type 3 (Wrisberg variant) discoid meniscus was not recorded in this group. In six (40%) patients, the discoid meniscus had a tear in it. The patients were followed up on average for 8 years and 4 months. In addition to subjective evaluation by patients, the treatment outcome was assessed using the Ikeuchi and Lysholm scoring systems. RESULTS: Arthroscopic partial meniscectomy was performed in 10 patients. In five patients conversion to open surgery was necessary and partial or subtotal fibular meniscectomy was carried out by minimally invasive arthrotomy from the lateral approach. Total meniscectomy was not required in any of our patients. The average value for treatment evaluation by the patients was 2.25 on a 1-to-5 scale. The average Lysholm pre-operative score of 80.8 points increased to 95.4 points after surgery. The long-term results assessed by the Ikeuchi system were excellent in nine, good in four and satisfactory in two patients. None of the patients showed poor results and no intraoperative or post-operative complications were recorded. DISCUSSION: Discoid meniscus is a painful condition affecting the knee, particularly when a tear is also present. Meniscal lesions are found intra-operatively in many symptomatic patients. The majority of international authors prefer arthroscopic management of discoid meniscus. The team of our department also support this procedure unanimously. Arthroscopy is used as the primary method with the aim of preserving the largest possible margin of the meniscus. Some literature data suggest that there are no statistically significant differences between an open and an arthroscopic procedure. Accordingly, in our patients no differences in the evaluation of treatment results were recorded. However, the advantages of minimally invasive arthroscopy for the management for discoid meniscus are beyond any doubt. CONCLUSIONS: The long-term results of discoid meniscus management reported in the international literature are very good. The results of long-term follow-up in our group give support to active surgical treatment. We take care to avoid total meniscectomy which often results in early development of secondary gonarthrosis.
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