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Knee Surgery, Sports Traumatology, Arthroscopy

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05-04-2023 | KNEE

Patients with discoid menisci have similar clinical outcomes to those without discoid menisci when undergoing surgical intervention: a systematic review

Authors: Yi David Diao, Prushoth Vivekanantha, Dan Cohen, Yuichi Hoshino, Kanto Nagai, Darren de SA

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 8/2023

Abstract

Purpose

To compare post-operative clinical outcomes of discoid meniscus tear procedures such as saucerization with or without repair with those of non-discoid meniscus tears such as meniscectomy or repair in skeletally mature patients with no concomitant injuries.

Methods

Three databases MEDLINE, PubMed and EMBASE were searched from inception to July 3rd, 2022 for literature describing patient-reported outcome measures after meniscus surgery in discoid or non-discoid meniscus tears. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Clinical outcome data on Lysholm, Tegner, International Knee Documentation Committee (IKDC), revision rates, and complications were recorded, with MINORS and Detsky scores used for quality assessment.

Results

A total of 38 studies comprising 2213 patients were included with a mean age of 38.6 years (range: 9.0–64.4). The mean follow-up time was 54.1 months (range: 1–234) and the average percentage of female participants was 46.8% (range: 9.5–95.5). The mean change between pre-operative and post-operative Lysholm scores ranged from 21.0–39.0, 7.4–24.1, and 24.2–48.4 in the discoid, non-discoid meniscectomy, and non-discoid repair groups, respectively. The mean change in Tegner scores ranged from 0.0 to 2.3, 1.3, and 0.4–1.3 in the discoid, non-discoid meniscectomy, and non-discoid repair groups, respectively. Pre-operative IKDC scores were not reported, however mean post-operative IKDC scores ranged from 77.4 to 96.0, 46.9 to 85.7, and 63.1 to 94.0 in discoid, non-discoid meniscectomy, and non-discoid repair groups, respectively. Revision rates for discoid procedures, non-discoid meniscectomies, and non-discoid meniscus repairs ranged from 3.2 to 44.0%, 8.3 to 56.0%, and 5.9 to 28.0%, respectively. The most common reasons for revision were acute trauma and persistent pain.

Conclusion

Discoid saucerization procedures with or without repair leads to similar Lysholm scores as non-discoid repair procedures, and similar IKDC scores and revision rates compared to non-discoid meniscectomy or repair procedures. Patients undergoing discoid procedures appeared to have slightly higher Tegner activity scores compared to patients undergoing non-discoid procedures; however this is to be considered in the context of a younger population of patients undergoing discoid procedures than non-discoid procedures. This information can help guide surgeons in the decision-making process when treating patients with discoid menisci, and should guide further investigations on this topic.

Level of evidence

IV.

Available only for authorised users

Al-Dadah O, Shepstone L, Donell ST (2021) Patient reported outcome measures in meniscal tears and arthroscopic meniscectomy: the value of outcome score prediction. Orthop Traumatol Surg Res 107:102803PubMedCrossRef

Alerskans S, Kostogiannis I, Neuman P (2022) Patient’s subjective knee function 3–5 years following partial meniscectomy or meniscus repair compared to a normal population: a retrospective cohort study. BMJ Open Sport Exerc Med 8:e001278. https://doi.org/10.1136/bmjsem-2021-001278PubMedPubMedCentralCrossRef

Atsumi S, Hara K, Arai Y, Kamitani A, Nakagawa S, Inoue H, Kubo T (2020) Outcomes of arthroscopic repair using the all-inside inter-leaf vertical suture technique for horizontal meniscal tears sustained in sports. Medicine 99:e22609. https://doi.org/10.1097/MD.0000000000022609PubMedPubMedCentralCrossRef

Bae J-H, Lim H-C, Hwang D-H, Song J-K, Byun J-S, Nha K-W (2012) Incidence of bilateral discoid lateral meniscus in an asian population: an arthroscopic assessment of contralateral knees. Arthroscopy 28:936–941PubMedCrossRef

Beck JJ, Schlechter J, Schmale G, Haus B, Lee J (2022) Comprehensive arthroscopic characterization of discoid meniscus tears and instability using the PRiSM discoid meniscus classification. Arthrosc Tech 11:e1347–e1352. https://doi.org/10.1016/j.eats.2022.03.018PubMedPubMedCentralCrossRef

Bin S-I, Jeong S-I, Kim J-M, Shon H-C (2002) Arthroscopic partial meniscectomy for horizontal tear of discoid lateral meniscus. Knee Surg Sports Traumatol Arthrosc 10:20–24PubMedCrossRef

Bogunovic L, Kruse LM, Haas AK, Huston LJ, Wright RW (2014) Outcome of all-inside second-generation meniscal repair: minimum five-year follow-up. J Bone Joint Surg 96:1303–1307PubMedPubMedCentralCrossRef

Burks RT, Metcalf MH, Metcalf RW (1997) Fifteen-year follow-up of arthroscopic partial meniscectomy. Arthroscopy 13:673–679PubMedCrossRef

Chatain F, Adeleine P, Chambat P, Neyret P (2003) A comparative study of medial versus lateral arthroscopic partial meniscectomy on stable knees: 10-year minimum follow-up. Arthroscopy 19:842–849PubMedCrossRef

10.

Choi N-H, Kim T-H, Son K-M, Victoroff BN (2010) Meniscal repair for radial tears of the midbody of the lateral meniscus. Am J Sports Med 38:2472–2476PubMedCrossRef

11.

Chung KS, Ha JK, Ra HJ, Yu WJ, Kim JG (2020) Root repair versus partial meniscectomy for medial meniscus posterior root tears: comparison of long-term survivorship and clinical outcomes at minimum 10-year follow-up. Am J Sports Med 48:1937–1944PubMedCrossRef

12.

Dammerer D, Fischer F, Mayr R, Giesinger J, El Attal R, Liebensteiner MC (2019) Temporary postoperative treatment with compartment-unloading knee braces or wedge insoles does not improve clinical outcome after partial meniscectomy. Knee Surg Sports Traumatol Arthrosc 27:814–821PubMedCrossRef

13.

Detsky AS, Naylor CD, O’Rourke K, McGeer AJ, L’Abbé KA (1992) Incorporating variations in the quality of individual randomized trials into meta-analysis. J Clin Epidemiol 45:255–265PubMedCrossRef

14.

Fillingham YA, Riboh JC, Erickson BJ, Bach BR, Yanke AB (2017) Inside-out versus all-inside repair of isolated meniscal tears: an updated systematic review. Am J Sports 45:234–242CrossRef

15.

Furumatsu T, Okazaki Y, Kodama Y, Okazaki Y, Masuda S, Kamatsuki Y, Takihira S, Hiranaka T, Yamawaki T, Ozaki T (2019) Pullout repair using modified Mason-Allen suture induces better meniscal healing and superior clinical outcomes: a comparison between two surgical methods. Knee 26:653–659PubMedCrossRef

16.

Golz AG, Mandelbaum B, Pace JL (2022) All-inside meniscus repair. Curr Rev Musculoskelet Med 15:252–258PubMedPubMedCentralCrossRef

17.

van de Graaf VA, Wolterbeek N, Mutsaerts ELAR, Scholtes VAB, Saris DBF, de Gast A, Poolman RW (2016) Arthroscopic partial meniscectomy or conservative treatment for nonobstructive meniscal tears: a systematic review and meta-analysis of randomized controlled trials. Arthroscopy 32:1855-1865.e4PubMedCrossRef

18.

Griffin JW, Hadeed MM, Werner BC, Diduch DR, Carson EW, Miller MD (2015) Platelet-rich plasma in meniscal repair: does augmentation improve surgical outcomes? Clin Orthop Relat Res 473:1665–1672PubMedPubMedCentralCrossRef

19.

Hashimoto Y, Nishino K, Reid JB, Yamasaki S, Takigami J, Tomihara T, Takahashi S, Shimada N, Nakamura H (2020) Factors related to postoperative osteochondritis dissecans of the lateral femoral condyle after meniscal surgery in juvenile patients with a discoid lateral meniscus. J Pediatr Orthop 40:e853–e859PubMedCrossRef

20.

Barak H, Shlomo B, Yona K, Rafael T (2015) Gender effect on the outcome of partial medial meniscectomy. Orthopedics 38:e925–e928

21.

He Y, Chen H, Fan Y, Zhou Y, Bao W (2022) Partial resection of lateral discoid meniscus changes lower limb axial alignment—a retrospective cohort study. Knee 37:171–179PubMedCrossRef

22.

Hiranaka T, Furumatsu T, Miyazawa S, Okazaki Y, Okazaki Y, Takihira S, Kodama Y, Kamatsuki Y, Masuda S, Saito T, Ozaki T (2020) Comparison of the clinical outcomes of transtibial pull-out repair for medial meniscus posterior root tear: two simple stitches versus modified Mason-Allen suture. Knee 27:701–708PubMedCrossRef

23.

Kaminski R, Kulinski K, Kozar-Kaminska K, Wasko MK, Langner M, Pomianowski S (2019) Repair augmentation of unstable, complete vertical meniscal tears with bone marrow venting procedure: a prospective, randomized, double-blind, parallel-group, placebo-controlled study. Arthroscopy 5:1500-1508.e1CrossRef

24.

Kaminski R, Kulinski K, Kozar-Kaminska K, Wielgus M, Langner M, Wasko MK, Kowalczewski J, Pomianowski S (2018) A prospective, randomized, double-blind, parallel-group, placebo-controlled study evaluating meniscal healing, clinical outcomes, and safety in patients undergoing meniscal repair of unstable, complete vertical meniscal tears (bucket handle) augmented with platelet-rich plasma. BioMed Res Int. https://doi.org/10.1155/2018/9315815CrossRef

25.

Kim C-W, Lee C-R, Gwak H-C, Kim J-H, Park D-H, Kwon Y-U, Jung S-H (2019) Clinical and radiologic outcomes of patients with lax healing after medial meniscal root repair: comparison with subtotal meniscectomy. Arthroscopy 35:3079–3086PubMedCrossRef

26.

Kim J-H, Chung J-H, Lee D-H, Lee Y-S, Kim J-R, Ryu K-J (2011) Arthroscopic suture anchor repair versus pullout suture repair in posterior root tear of the medial meniscus: a prospective comparison study. Arthroscopy 27:1644–1653PubMedCrossRef

27.

Kim J-R, Kim B-G, Kim J-W, Lee J-H, Kim J-H (2013) Traumatic and non-traumatic isolated horizontal meniscal tears of the knee in patients less than 40 years of age. Eur J Orthop Surg Traumatol 23:589–593PubMedCrossRef

28.

Kim SB, Ha JK, Lee SW, Kim DW, Shim JC, Kim JG, Lee MY (2011) Medial meniscus root tear refixation: comparison of clinical, radiologic, and arthroscopic findings with medial meniscectomy. Arthroscopy 27:346–354PubMedCrossRef

29.

Kimura M, Shirakura K, Higuchi H, Kobayashi Y, Takagishi K (2004) Eight- to 14-year followup of arthroscopic meniscal repair. Clin Orthop Relat Res 421:175–180CrossRef

30.

Koç A, Tokmak TT, Karabıyık Ö, Türk G (2019) Evaluation of anterior intermeniscal ligament in discoid lateral meniscus cases and presenting the accompanying meniscal pathologies with MRI. Acta Radiol 60:100–105PubMedCrossRef

31.

Kocher MS, Logan CA, Kramer DE (2017) Discoid lateral meniscus in children: diagnosis, management, and outcomes. J Am Acad Orthop Surg 25(11):736–743PubMedCrossRef

32.

Krych AJ, Johnson NR, Mohan R, Dahm DL, Levy BA, Stuart MJ (2017) Partial meniscectomy provides no benefit for symptomatic degenerative medial meniscus posterior root tears. Knee Surg Sports Traumatol Arthrosc 26(4):1117–1122PubMed

33.

Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174PubMedCrossRef

34.

Le N, Blackman B, Zakharia A, Cohen D, de Sa D (2022) MPFL repair after acute first-time patellar dislocation results in lower redislocation rates and less knee pain compared to rehabilitation: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-022-07222CrossRefPubMed

35.

Lee D-H, D’Lima DD, Lee SH (2019) Clinical and radiographic results of partial versus total meniscectomy in patients with symptomatic discoid lateral meniscus: a systematic review and meta-analysis. Orthop Traumatol Surg Res 105:669–675PubMedCrossRef

36.

Lee DW, Jang HG, Lee YJ, Moon SG, Kim NR, Kim JG (2020) Effect of atelocollagen on the healing status after medial meniscal root repair using the modified Mason-Allen stitch. Orthop Traumatol Surg Res 106:969–975PubMedCrossRef

37.

Lee DW, Kim MK, Jang HS, Ha JK, Kim JG (2014) Clinical and radiologic evaluation of arthroscopic medial meniscus root tear refixation: comparison of the modified mason-allen stitch and simple stitches. Arthroscopy 30:1439–1446PubMedCrossRef

38.

Lee RJ, Nepple JJ, Schmale GA, Niu EL, Beck JJ, Milewski MD, Finlayson CJ, Joughin VE, Stinson ZS, Pace JL, PRiSM Meniscus Research Interest Group, Albright J, Carsen S, Chambers H, Nault M-L, Schlechter JA, Stavinoha TJ, Tompkins M, Wilson PL, Heyworth BE (2022) Reliability of a new arthroscopic discoid lateral meniscus classification system: a multicenter video analysis. Am J Sports Med 50:1245–1253PubMedCrossRef

39.

Lee YS, Teo SH, Ahn JH, Lee O-S, Lee SH, Lee JH (2017) Systematic review of the long-term surgical outcomes of discoid lateral meniscus. Arthroscopy 33:1884–1895PubMedCrossRef

40.

Liao Y-H, Chen C-H, Lin C-J, Su W-R, Shih C-L, Chiang C-H (2022) Young children with a bucket-handle tear to the discoid lateral meniscus successfully treated using arthroscopic saucerization and repair: two case reports. Medicina (Kaunas) 58(10):1403. https://doi.org/10.3390/medicina58101403PubMedCrossRef

41.

Lind M, Nielsen T, Faunø P, Lund B, Christiansen SE (2013) Free rehabilitation is safe after isolated meniscus repair: a prospective randomized trial comparing free with restricted rehabilitation regimens. Am J Sports Med 41:2753–2758PubMedCrossRef

42.

Lins LAB, Feroe AG, Yang B, Williams KA, Kocher SD, Sankarankutty S, Micheli LJ, Kocher MS (2021) Long-term minimum 15-year follow-up after lateral discoid meniscus rim preservation surgery in children and adolescents. J Pediatr Orthop 41(9):e810–e815PubMed

43.

Lu Y, Li Q, Hao J (2007) Torn discoid lateral meniscus treated with arthroscopic meniscectomy: observations in 62 knees. Chin Med J (Engl) 120:211–215PubMedCrossRef

44.

Lutz C, Dalmay F, Ehkirch F-P, Cucurulo T, Laporte C, Le Henaff G, Potel J-F, Pujol N, Rochcongar G, Salledechou E, Seil R, Gunepin F-X, Sonnery-Cottet B (2015) Meniscectomy versus meniscal repair: 10years radiological and clinical results in vertical lesions in stable knee. Orthop Traumatol Surg Res 101:S327–S331PubMedCrossRef

45.

Niu EL, Lee RJ, Joughin E, Finlayson CJ, Heyworth BE (2022) Discoid meniscus. Clin Sports Med 41:729–747PubMedCrossRef

46.

Patel NM, Mundluru SN, Beck NA, Ganley TJ (2019) Which factors increase the risk of reoperation after meniscal surgery in children? Orthop J Sports Med 7:2325967119842885PubMedPubMedCentralCrossRef

47.

Paxton ES, Stock MV, Brophy RH (2011) Meniscal repair versus partial meniscectomy: a systematic review comparing reoperation rates and clinical outcomes. Arthroscopy 27:1275–1288PubMedCrossRef

48.

Perdue PS Jr, Hummer CD III, Colosimo AJ, Heidt RS Jr, Dormer SG (1996) Meniscal repair: outcomes and clinical follow-up. Arthroscopy 12:694–698PubMedCrossRef

49.

Perkins CA, Busch MT, Christino MA, Willimon SC (2021) Saucerization and repair of discoid lateral menisci with peripheral rim instability: intermediate-term outcomes in children and adolescents. J Pediatr Orthop 41:23–27PubMedCrossRef

50.

Poh S-Y, Yew K-SA, Wong P-LK, Koh S-BJ, Chia S-L, Fook-Chong S, Howe T-S (2012) Role of the anterior intermeniscal ligament in tibiofemoral contact mechanics during axial joint loading. Knee 19:135–139PubMedCrossRef

51.

Rodríguez-Roiz JM, Sastre-Solsona S, Popescu D, Montañana-Burillo J, Combalia-Aleu A (2020) The relationship between ACL reconstruction and meniscal repair: quality of life, sports return, and meniscal failure rate—2- to 12-year follow-up. J Orthop Surg 15:361. https://doi.org/10.1186/s13018-020-01878-1CrossRef

52.

Roos EM, Hare KB, Nielsen SM, Christensen R, Lohmander LS (2018) Better outcome from arthroscopic partial meniscectomy than skin incisions only? A sham-controlled randomised trial in patients aged 35–55 years with knee pain and an MRI-verified meniscal tear. BMJ Open 8:e019461PubMedPubMedCentralCrossRef

53.

Saavedra M, Sepúlveda M, Jesús Tuca M, Birrer E (2020) Discoid meniscus: current concepts. EFORT Open Rev 5:371–379PubMedPubMedCentralCrossRef

54.

Sallé de Chou E, Pujol N, Rochcongar G, Cucurulo T, Potel J-F, Dalmay F, Ehkirch F-P, Laporte C, Le Henaff G, Seil R, Lutz C, Gunepin F-X, Sonnery-Cottet B (2015) Analysis of short and long-term results of horizontal meniscal tears in young adults. Orthop Traumatol Surg Res 101:S317–S322PubMedCrossRef

55.

Shieh AK, Edmonds EW, Pennock AT (2016) Revision meniscal surgery in children and adolescents: risk factors and mechanisms for failure and subsequent management. Am J Sports Med 44:838–843PubMedCrossRef

56.

Sihvonen R, Paavola M, Malmivaara A, Itälä A, Joukainen A, Kalske J, Nurmi H, Kumm J, Sillanpää N, Kiekara T, Turkiewicz A, Toivonen P, Englund M, Taimela S, Järvinen TLN (2020) Arthroscopic partial meniscectomy for a degenerative meniscus tear: a 5 year follow-up of the placebo-surgery controlled FIDELITY (Finnish Degenerative Meniscus Lesion Study) trial. Br J Sports Med 54:1332–1339PubMedCrossRef

57.

Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (MINORS): development and validation of a new instrument. ANZ J Surg 73:712–716PubMedCrossRef

58.

Smuin DM, Swenson RD, Dhawan A (2017) Saucerization versus complete resection of a symptomatic discoid lateral meniscus at short- and long-term follow-up: a systematic review. Arthroscopy 33:1733–1742PubMedCrossRef

59.

Sochacki KR, Varshneya K, Calcei JG, Safran MR, Abrams GD, Donahue J, Sherman SL (2020) Comparing meniscectomy and meniscal repair: a matched cohort analysis utilizing a national insurance database. Am J Sports Med 48:2353–2359PubMedCrossRef

60.

Tudisco C, Botti F, Bisicchia S (2019) Histological study of discoid lateral meniscus in children and adolescents: morphogenetic considerations. Joints 7:155–158PubMedCrossRef

61.

Tyler PA, Jain V, Ashraf T, Saifuddin A (2022) Update on imaging of the discoid meniscus. Skeletal Radiol 51:935–956PubMedCrossRef

62.

Ulku TK, Kaya A, Kocaoglu B (2020) Suture configuration techniques have no effect on mid-term clinical outcomes of arthroscopic meniscus root repairs. Knee 27:676–682PubMedCrossRef

63.

Uzun E, Misir A, Kizkapan TB, Ozcamdalli M, Akkurt S, Guney A (2018) Arthroscopic medial meniscal repair with or without concurrent anterior cruciate ligament reconstruction: a subgroup analysis. Knee 25:109–117PubMedCrossRef

64.

Vivekanantha P, Kahlon H, Cohen D, de Sa D (2022) Isolated medial patellofemoral ligament reconstruction results in similar postoperative outcomes as medial patellofemoral ligament reconstruction and tibial-tubercle osteotomy: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-022-07186-xCrossRefPubMed

65.

Wasser L, Knörr J, Accadbled F, Abid A, Sales De Gauzy J (2011) Arthroscopic treatment of discoid meniscus in children: clinical and MRI results. Orthop Traumatol Surg Res 97:297–303PubMedCrossRef

66.

Zheng Z-R, Ma H, Yang F, Yuan L, Wang G-D, Zhao X-W, Ma L-F (2022) Discoid medial meniscus of both knees: a case report. World J Clin Cases 10:9020–9027PubMedPubMedCentralCrossRef

Title: Patients with discoid menisci have similar clinical outcomes to those without discoid menisci when undergoing surgical intervention: a systematic review
Authors: Yi David Diao
Prushoth Vivekanantha
Dan Cohen
Yuichi Hoshino
Kanto Nagai
Darren de SA
Publication date: 05-04-2023
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 8/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-023-07398-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Patients with discoid menisci have similar clinical outcomes to those without discoid menisci when undergoing surgical intervention: a systematic review

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

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