Discoid lateral meniscus instability in children: part II.: Repair first to minimise the saucerisation

Paul Henri Bauwens; Simon Vandergugten; Charles Fiquet; Sébastien Raux; Nicolas Cance; Franck Chotel

doi:10.1007/s00167-023-07538-1

Discoid lateral meniscus instability in children: part II.: Repair first to minimise the saucerisation

Knee Surg Sports Traumatol Arthrosc. 2023 Nov;31(11):4816-4823. doi: 10.1007/s00167-023-07538-1. Epub 2023 Sep 2.

Authors

Paul Henri Bauwens¹, Simon Vandergugten², Charles Fiquet³, Sébastien Raux¹, Nicolas Cance¹, Franck Chotel⁴

Affiliations

¹ Department of Pediatric Orthopaedic Surgery, Lyon University Hospital for Mother and Children, 59 Boulevard Pinel, 69677, Bron, France.
² Pediatric Orthopaedic Surgery Unit, Cliniques Universitaires UCL Saint-Luc Bruxelles, and in Grand Hopital de Charleroi, Lyon, France.
³ Clinique de l'infirmerie Protestante of Lyon, 1-3 Chemin du Penthod, 69300, Caluire et Cuire, France.
⁴ Department of Pediatric Orthopaedic Surgery, Lyon University Hospital for Mother and Children and Claude Bernard University Lyon I., Hospices Civils de Lyon, 59 Boulevard Pinel, 69677, Bron, France. franck.chotel@yahoo.co.uk.

PMID: 37659011
DOI: 10.1007/s00167-023-07538-1

Abstract

Purpose: Despite an improved understanding of discoid lateral meniscus (DLM), the treatment of symptomatic discoid lateral meniscus remains controversial.

Methods: The aim of this retrospective, single-centred, consecutive-case study was to evaluate the clinical outcome of 60 DLM treated arthroscopically by the "meniscoplasty or saucerisation-suture" technique in children and adolescents [median (range) age 11 (4-17) years], and to investigate surgical failures. The instability was assessed before any saucerisation. The hypotheses were that: (i) the management of instability with suture first was effective and that (ii) a combined classification with clinical and MRI data had a prognostic value.

Results: In 57 knees (95%), the DLM was unstable, and a suture fixation was performed. After a median follow-up of 41.5 months, the median (range) IKDC score was improved from 55 (10-70) preoperatively to 90 (37.5-100) postoperatively. The median (range) Lysholm score at last follow-up was 93.5 (45-100). The procedure was effective in 49 knees (81.6%) after a single procedure. Eleven patients had a failure with a new meniscal tear after a median (range) delay of 42 months (24-60) after the initial procedure. The patterns of discoid lateral meniscus instability were not found to have a prognostic value for surgical failure since they mainly occurred after sport-related injuries. All the patients with initial repair failures but one achieved a good clinical outcome after revision repair without any further meniscectomy.

Conclusion: In contrast to adult knees, symptomatic discoid lateral meniscus is rarely stable in children (5%). Meniscal repair is effective to preserve the meniscus tissue, but revision repair became necessary in 18% of the cases and was finally successful. Level of evidence Level III.

Keywords: Arthroscopy; Children; Clinical pattern; Discoid lateral meniscus; Failure; Instability; Knee; MRI; Paediatric; Repair; Results; Suture.