Purpose: To systematically review the available literature in patients with discoid lateral meniscus (DLM) with the goal of elucidating the rates and types of meniscal tears, clinical symptoms, treatment strategies, and postoperative clinical, and radiographic outcomes in adult patients compared with a pediatric population.
Methods: A literature search was performed using the PubMed, Embase, and Scopus databases from database inception to October 2023 according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Level of evidence I through IV human clinical studies evaluating rate and type of meniscal tears, clinical symptoms, patient-reported outcome measures, and postoperative radiographical assessments in patients with DLM were included. Comparisons were made by age below and above 16 years. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria.
Results: Thirteen studies comprising of 1772 adult patients (>16 years old) with DLM (n=1856 knees) and eight studies conducted in 304 pediatric patients (≤16 years old, n=353 knees) were include. The reported mean age ranged from 22.4 to 45 years (mean follow-up, 24 to 157.5 months) in the adult group and from 5 to 12.9 years (mean follow-up,37 to 234 months) in the pediatric DLM group. The majority of adult (n=553; 96.5%) and pediatric (n=163; 71.8%) patients had tears of the DLM. Complete DLM was the predominant type of DLM in both study groups (range in adults, 49.6 to 88%; range in pediatric, 19 to 100%) with complex (46.1%; range, 5.3-100%) and horizontal tears (18.2%; range, 20-37.5) being the most frequently described tear patterns in the adult and pediatric DLM groups, respectively. Pain was the predominant reported symptom in both study groups (range in adults, 12.1 to 99.3%; range in pediatrics, 32.4 to 100%). Partial meniscectomy was the most frequently reported treatment option conducted in 334 adult (39.5%; range, 24.2-100%) and 66 pediatric knees (63.5%; range, 15-100%).. Overall, improved postoperative clinical outcomes were reported in both study groups; however, radiographic progression of degenerative changes after subtotal meniscectomy was noted.
Conclusions: More adult patients with DLM present with tears in the literature compared with the pediatric population. Complex and horizontal tear patterns are the most frequently reported tears in adult and pediatric patients, respectively. . Pain is the most relevant symptom in both study groups. There was generally significant improvement in postoperative clinical outcome scores; partial meniscectomy however remains the most frequently reported treatment option and is associated with fewer degenerative changes than in subtotal meniscectomy. .
Study design: Level IV, Systematic review of Level I-IV studies.
Copyright © 2024. Published by Elsevier Inc.