Arthroscopic one-piece reshaping for symptomatic discoid medial meniscus with anomalous amalgamating into anterior cruciate ligament

Discoid shapes of lateral menisci are relatively common finding, whereas discoid medial menisci are less common. Discoid medial meniscus with associated anomalous variants has been reported. However, symptomatic complex tear of complete type discoid medial meniscus with anomalous blending with anterior cruciate ligament is an extremely rare pathology. A 35-year-old male was admitted to our hospital with left knee pain and loss of terminal extension for 2 years. On physical examination, the patient presented with clicking and restriction during the extension motion of the knee joint. Magnetic resonance imaging and arthroscopy indicated complex tear of complete discoid medial meniscus in association with anomalous connection between entire apical portion of discoid medial meniscus and tibial insertion portion of the anterior cruciate ligament. We obtained a successful outcome with arthroscopic resection and shaping in one-piece method using no. 11 scalpel blade.     

Bilateral complete discoid medial menisci combined with anomalous insertion and cyst formation

A female student had a complete discoid medial meniscus of right knee combined with a meniscal cyst and anomalous insertion to the anterior cruciate ligament. This was confirmed by magnetic resonance imaging (MRI) and the arthroscopic procedure. Also shown by the MRI, the left knee had the discoid medial meniscus, but it was asymptomatic.     

Discoid medial meniscus with a horizontal cleavage tear: a juvenile who suffered for 3 years

It is very rare to see medial discoid meniscus, and there have been only 82 knees in 61 cases reported to date. The investigators found discoid medial meniscus with horizontal cleavage tear in a 13-year-old juvenile who had been injured while playing basketball, and endured for 3 years. Both magnetic resonance images and the arthroscopic findings were presented. Saucerization of the torn discoid medial meniscus was performed successfully, and the clinical outcomes were satisfying according to the follow-up of 14 months.     

Surgical treatment of symptomatic discoid medial meniscus in childhood: a case report

If the meniscus has a spherical shape and not a semilunary structure, it is called as discoid meniscus. This anomaly is generally seen in the lateral meniscus; however, it is rare in the medial meniscus. Although the discoid meniscus is usually asymptomatic in children and adolescents, it could present as a meniscal tear. An 11-year-old boy was admitted to our hospital with right knee pain and lack of extension of the knee joint. He was diagnosed as discoid medial meniscus. On physical examination, we observed tenderness at the knee joint line with an effusion of the knee and a restriction during the extension movement of the knee joint. McMurray test was positive. Conventional radiograms revealed widening of the medial joint line and cupping of the medial tibial plateau. Magnetic resonance imaging indicated a discoid meniscus image at sagittal slices. In this case, after the arthroscopic partial menisectomy, we obtained an excellent result at 2 years follow-up.     

Bilateral Discoid Medial Menisci

Summary: This article adds 2 more cases of bilateral discoid medial menisci to the previously reported 9 cases. The radiographs of the first case revealed bilateral cupping of the medial tibial plateaus and a small lytic lesion of the left distal medial femoral metaphysis. Beside the posteriorly unstable incomplete type discoid medial meniscus, the left knee had several associated arthroscopic findings: depression of the medial tibial plateau with exposed subchondral bone, anomalous insertion of the anterior horn of the discoid meniscus to the anterior cruciate ligament, a pathological medial plica, and longitudinal deep fissures in the trochlea. The second case was a complete type with peripheral horizontal cleavage tears. Following arthroscopic surgery, magnetic resonance imaging (MRI) scans of the contralateral knees were obtained in both cases to search for bilaterality. MRI revealed discoid medial menisci in the unoperated knees as well. The short-term results of arthroscopic meniscectomy may not be as satisfactory as those reported for normal menisci.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 16, No 1 (January-February), 2000: pp 96–101     

半月板成形和缝合治疗累及腘肌腱裂孔的盘状软骨损伤

目的 总结关节镜下半月板成形和胴肌腱裂孔前、后缝合治疗累及腘肌腱裂孔的外侧盘状软骨损伤临床疗效.方法 2008年1月-2009年5月,收治21例累及腘肌腱裂孔的外侧盘状软骨损伤患者.男9例,女12例;年龄12～45岁,平均22.5岁.左膝12例,右膝9例.7例既往有外伤史,14例无明确外伤史.病程3个月～2年,平均6....     

Posteriorly inserted anterior cruciate ligament in knees with discoid lateral meniscus corresponding to bony morphological characteristics of femoral lateral condyle

Purpose

Discoid meniscus often causes mechanical problems and needs surgical treatment at an early age. However, many aspects of its morphological development and changes remain unknown. The purpose of this study was to investigate the insertion of the femoral anterior cruciate ligament (ACL) via the behind-ACL approach and the morphology of the lateral femoral condyle to which the ACL attaches to clarify the morphological characteristics of the knee with discoid lateral meniscus (DLM).

Knee joint hemarthrosis--differential diagnostic considerations for planning an operation

From 1980 to the end of 1988, arthroscopy has been performed on 620 patients with acute hemarthrosis of the knee joint. Of all the intraarticular lesions, 89.4% required surgery. Arthroscopy has changed in the last decade from diagnostic screening to invasive instrumentation for exact operative planing and alternative operative techniques. Hemarthrosis in stable knee joints was caused by minor lesions (7.84%) that did not require surgical procedures. Seventy-three patients had traumatic patellar dislocations--in 33 cases associated with chondral or osteochondral fractures. In 54.8% of the isolated medial retinacular ruptures, simple suture was performed in 14 cases--3 times arthroscopically and 11 times open, combined with lateral retinacular release without redislocation following. Associated chondral fracture indicated surgery in all cases. Isolated meniscus pathology (12.48%) was treated by arthroscopy alone, and refixation of the medial meniscus was carried out using the inside-out technique in 27 cases. Arthroscopic elevation of lateral tibia plateau fracture--indicated by type II fracture according to the AO classification--was performed in 3 cases with excellent results, and was associated with screw fixation and image intensification in 2 patients. Intercondylar eminence fracture is an excellent indication for arthroscopic refixation in the presence of the mono- or two-fragment type of fracture. ACL rupture is the main intra-articular pathology (64.8%) for hemarthrosis of the knee joint, which was diagnosed as an acute injury within the 1st week following trauma (51.04%). Anterior instability can be detected clinically if a careful examination with the Lachman test, combined with the missing end-point and pivot-shift test, is performed.(ABSTRACT TRUNCATED AT 250 WORDS)     

Entrapment of the meniscus in a fracture of the intercondylar eminence of the tibia

Summary: Entrapment of the meniscus in a fracture of the tibial intercondylar eminence is very rare. We have experienced 2 cases of it and report on them to emphasize the importance of diagnostic arthroscopy especially for meniscal injuries in tibial intercondylar eminence fracture. Our case series was composed of 2 patients (a 30-year-old man and a 54-year-old woman). Both had been in a car accident and showed a type III fracture of the tibial intercondylar eminence on the initial radiographs. During arthroscopic examination, we found a bucket-handle tear of the lateral meniscus, and, in 1 case, the entire torn portion was displaced medially and entrapped in the fracture site, and in the other case, a longitudinally torn medial meniscus (the mid to anterior horn), of which the torn portion of the medial meniscus was rotated internally and entrapped in the fracture site. They were treated with arthroscopic meniscal repair or partial meniscectomy with pullout suture for the fracture of the tibial eminence. The results were excellent. At 6-month follow-up, the woman denied any pain and limitation of motion. At 1-year follow-up in the other case, the man did not have any complaint except slight limitation of knee flexion due to arthrofibrosis. After arthroscopic fibrolysis in the second-look operation, he showed normal range of motion of the knee. In conclusion, entrapped meniscus can cause pain, lack of full knee extension, and minimal anterior instability. Also, it tends to hinder the reduction of a fracture of the tibial eminence. Thus, arthroscopy should be diagnostic, and release of the trapped meniscus, if present, with partial meniscectomy or meniscal repair would be expected to relieve the symptoms.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 16, No 4 (May-June), 2000: pp 7–7     

Usefulness of knee arthroscopy for diagnosis of knee pain in pediatric patients: comparison with preoperative clinical diagnosis

Purpose

To investigate the knee arthroscopic findings of pediatric patients with knee pain.

Subjects

Ninety-five knees of 94 patients (46 males and 48 females) aged 15 years or younger who underwent knee arthroscopy during a 4-year period from January 2007 were studied. The mean age at surgery was 13.5 (7–15) years. The mean interval from symptom onset to arthroscopic examination was 6.8 months (5 days to 2 years 10 months).

Results

The most common cause of knee pain was sports-related activities (64 knees). Other causes included falling from a moving bicycle (5 knees), while knee pain appeared with no defined reason in 14 knees. The most frequent final diagnosis based on knee arthroscopic findings was anterior cruciate ligament (ACL) injury (35 knees), followed by discoid lateral meniscus (16 knees), lateral meniscal tear (11 knees), and medial plica syndrome (9 knees), while no arthroscopic abnormality was observed in 8 of 95 knees. Among the 95 knees, the diagnosis based on preoperative physical tests and imaging findings was different from the arthroscopic diagnosis in 16 knees, 8 of which were diagnosed preoperatively as medial meniscal tear.

Conclusion

ACL injury and discoid lateral meniscus were the predominant conditions in pediatric patients who underwent knee arthroscopic surgery for knee pain. Knee arthroscopy is useful to provide a definitive diagnosis for knee pain in pediatric patients. Preoperative evaluations had a diagnostic accuracy of only 83.2 % and failed to diagnose conditions such as medial plica syndrome and chondral injury. Therefore, diagnosis before knee arthroscopy has to be interpreted with caution.     

Arthroscopic treatment of symptomatic discoid lateral meniscus in a 26-month-old girl

Discoid lateral meniscus is a well-documented pathology, but symptomatic discoid lateral meniscus in a very young child and arthroscopic management are extremely rarely reported. We report a case of symptomatic discoid lateral meniscus in a 26-month-old girl who showed limping and extension loss after a minor trauma. Physical examination revealed clicking and 10° terminal extension loss, which was suggestive of the torn discoid meniscus. Magnetic resonance imaging showed discoid lateral meniscus with intrameniscal tear. Treatment consisted of arthroscopic one-piece excision technique with conventional arthroscopic instrument and a No. 11 blade. A good subjective and objective functional outcome has been obtained after 35 months of follow-up evaluation.     

Medial discoid meniscus completely coalesced with the anterior cruciate ligament

Medial discoid meniscus is an uncommon abnormality. To date, only a few reports have described the associated anomaly with discoid meniscus. However, there are no reports on medial discoid meniscus accompanied by an anomaly of the meniscus itself. The authors found that a medial discoid meniscus completely coalesced with the anterior cruciate ligament. This anomaly strongly supports the congenital development theory of discoid meniscus. Both magnetic resonance imaging and the arthroscopic findings are presented. The patient was treated successfully by saucerization of the discoid meniscus up to the torn edge. This was accomplished by closely cutting the meniscus around the anterior cruciate ligament with an electric cutter.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 7 (September), 2001: E27     

Knee dislocation following anterior cruciate ligament disruption without any other ligament tears.

We report a rare case of complete knee dislocation following anterior cruciate ligament (ACL) disruption without any other ligament tears. The pathology of the knee joint was torn ACL, intact other ligaments, osteochondral fractures and bone bruise of the lateral femoral condyle, and torn lateral meniscus. In this case, osteochondral fracture resulting from the anteriorly sublaxiation of the tibia following ACL disruption was considered to prevent from spontaneous reduction. This case suggests that anterolateral knee dislocation and spontaneous reduction may occur in ACL injuries.     

Arthroscopic meniscectomy for discoid lateral meniscus in children and adolescents: 4.5 year follow-up

We retrospectively reviewed the 4.5 year (range, 21-88 months) follow-up results of arthroscopic partial meniscectomies performed in 11 knees between 1994 and 2000 to treat a symptomatic discoid lateral meniscus. The average age at surgery was 11.5 years (range, 5-17 years). All except one of the discoid menisci were of a complete type, and all except three were torn menisci. At the latest follow-up examination, the result was excellent for nine knees, and good for two; no degenerative changes were evident on the roentgenograms. Arthroscopic partial meniscectomy should be the treatment of choice for the complete type symptomatic lateral discoid meniscus, even if it is intact. Preoperative lack of the knee extension requires a gentle rehabilitation program postoperatively.     

Osteochondral Grafting for Treatment of a Massive Chondral Defect in the Knee of a Young Adult With Anterior Cruciate Ligament Deficit

We report the case of a 28-year-old woman who underwent osteochondral grafting and anterior cruciate ligament (ACL) reconstruction for treatment of a massive cartilage defect in a knee joint with ACL deficit. Arthroscopy showed a full-thickness degenerative cartilage defect measuring 22 × 35 mm in the weight-bearing area of the medial femoral condyle, a totally resected lateral meniscus, and a loosened ACL. Therefore we performed osteochondral autograft transplantation and ACL reconstruction. Osteochondral plugs were harvested from a donor site in the patellofemoral joint of the contralateral knee and grafted into the recipient site in a “skipping” manner. Arthroscopic examination 1 year after surgery showed good preservation of the grafts and satisfactory bridging of the gaps between the plugs with fibrocartilage-like tissue. A recent follow-up examination, performed 36 months after surgery, has shown an excellent result, with a Lysholm score of 100, an International Knee Documentation Committee score of 95.4, and full range of knee motion with no symptoms. Plain radiographs at that time showed preservation of the medial joint space on the weighted anteroposterior view. No osteoarthritic changes were evident in the patellofemoral joint.     

Combined Injury to the ACL and Lateral Meniscus Alters the Geometry of Articular Cartilage and Meniscus Soon After Initial Trauma

Combined injury to the anterior cruciate ligament (ACL) and meniscus is associated with earlier onset and increased rates of post-traumatic osteoarthritis compared with isolated ACL injury. However, little is known about the initial changes in joint structure associated with these different types of trauma. We hypothesized that trauma to the ACL and lateral meniscus has an immediate effect on morphometry of the articular cartilage and meniscus about the entire tibial plateau that is more pronounced than an ACL tear without meniscus injury. Subjects underwent magnetic resonance imaging scanning soon after injury and prior to surgery. Those that suffered injury to the ACL and lateral meniscus underwent changes in the lateral compartment (increases in the posterior–inferior directed slopes of the articular cartilage surface, and the wedge angle of the posterior horn of the meniscus) and medial compartment (the cartilage-to-bone height decreased in the region located under the posterior horn of the meniscus, and the thickness of cartilage increased and decreased in the mid and posterior regions of the plateau, respectively). Subjects that suffered an isolated ACL tear did not undergo the same magnitude of change to these articular structures. A majority of the changes in morphometry occurred in the lateral compartment of the knee; however, change in the medial compartment of the knee with a normal appearing meniscus also occurred. Statement of clinical significance: Knee injuries that involve combined trauma to the ACL and meniscus directly affect both compartments of the knee, even if the meniscus and articular cartilage appears normal upon arthroscopic examination. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:759-767, 2020     

Analysis of the discoid meniscus in Koreans.

Discoid meniscus is a relatively common disorder of the knee in Koreans. Its arthroscopic treatment is one of the most technically demanding procedures of this field. The purposes of this study were to define the clinical features of the discoid meniscus in Koreans and to suggest an adequate arthroscopic technique. We performed arthroscopic meniscectomy on 37 knees with a lateral discoid meniscus. The average length of follow up was 21 months. The presence of synovial hypertrophy in the knee with discoid was significantly higher than that with a non-discoid meniscal lesion. A medial midpatellar portal for the arthroscope is advisable for clean arthroscopic surgery in this situation. We obtained satisfactory results through the partial resection of the discoid meniscus, leaving the normal semilunar-shaped meniscus intact as much as possible.     

The accuracy of joint line tenderness by physical examination in the diagnosis of meniscal tears

Purpose: The purpose of this study was to document the accuracy of joint line tenderness in the diagnosis of meniscal tears. Type of Study: Prospective cohort study. Methods: There were 104 male recruits (age range, 18 to 20 years; mean, 19.2 years) with suspected meniscal lesions who underwent arthroscopy. A thorough history and physical examination was performed on each patient by a physician with 4 years’ experience on arthroscopic knee surgery. Twenty-six (25%) patients sustained injuries while in the Turkish Army, and 78 patients (75%) sustained injuries before they came to the army. On physical examination, assessment of joint line tenderness at the lateral and medial joint lines was performed with the patient’s knee flexed 90°. The accuracy, sensitivity, specificity, and positive and negative predictive values of joint line tenderness for medial and lateral sides were calculated based on arthroscopic findings. Results: In 104 knees, the diagnosis was correct in 71 (68%) and incorrect in 33 (32%) knees. A total of 37 medial meniscal tears and 27 lateral meniscal tears were identified at arthroscopy. Other pathology included 11 anterior cruciate ligament (ACL) tears, 5 medial femoral chondral lesions, 4 chondromalacia patellae, and 1 medial plica. No discernable abnormalities were seen in 21 knees. A preoperative diagnosis of a medial meniscal tear was made in 54 knees and 32 were confirmed at arthroscopy. A lateral meniscus tear was suspected in 27 knees and confirmed in 25. Five medial meniscus and 2 lateral meniscus tears were seen at arthroscopy. These had not been suspected with tenderness over the joint line. The accuracy of the test was lower with the presence of ACL lesions and condromalacia patella. Conclusions: I concluded that joint line tenderness as a test for lateral meniscal tears is accurate (96%), sensitive (89%), and specific (97%). However, for medial meniscal tears, rates are lower.     

Kombinierte Verletzung des Innen- und Außenmeniskus und des vorderen Kreuzbandes

THE PROBLEM: Combined injury of the medial and lateral meniscus and the anterior cruciate ligament. THE SOLUTION: One-stage arthroscopic treatment of all injuries. Repair of the bucket-handle tears with sutures and arrow-shaped implants. SURGICAL TECHNIQUE: Arthroscopy of the knee joint, repositioning of the buckethandle tears of the medial and lateral menisci. Evaluation of the stability of the menisci without sutures, insertion of horizontal and vertical sutures through the menisci in inside-out technique, refixation of the posterior horns with arrow-shaped meniscus implants. Reconstruction of the anterior cruciate ligament with a patellar tendon transplant. Knotting of the suture loops through the menisci directly onto the capsule. RESULT: Stable knee joint capable of load bearing and without signs of irritation after 12 weeks with a range of motion of 0/0/130 degrees. Slight muscle deficit in the right thigh.     

关节镜下治疗盘状半月板疗效及其影响因素分析

目的总结我院21例关节镜下治疗外侧盘状半月板的临床效果,分析影响盘状半月板疗效的因素。方法选择2008年1月至2011年1月关节镜下行外侧盘状半月板手术的患者21例,其中男性8例,女性13例;年龄18～56岁,平均40.9岁。术后21例患者均获得随访,随访时间9～35个月,平均22.3个月。结果所有随访的患者手术后临床症状基本消失,术后6个月按Ikeuchi评分进行评估,优17例,良3例,可1例,优良率95.23%。手术前后Lysholm评分、Tegner运动能力评分具有明显的差异性(P=0.000)。年龄与半月板的分型在一定程度上影响盘状半月板的临床疗效,而性别、外伤史、撕裂方式、手术方式没有明显的影响。结论关节镜下治疗外侧盘状半月板的临床疗效是值得肯定的,且关节镜手术具有创伤小、诊治结合、术后恢复快的特点,是治疗盘状半月板损伤的有效方式。