Discoid Meniscus Treatment Mehran Soleymanha (Ass. Prof. GUMS , Knee surgery fellowship, SBUMS, Akhtar Hospital) I.O.A Meeting – Tehran – Aug .25.2016

Watanabe Classification Type I: complete disc-shaped meniscus Type II: incomplete semi-lunar- shaped meniscus Type III: Wrisberg type (hyper-mobile meniscus) Watanabe M, Takeda S, Ikeuchi H. Atlas of arthroscopy. Tokyo: Igaku-Shoin, 1978;88.

Discoid Meniscus Complete – Incomplete Stable – Unstable anterior instability posterior instability Good CR, et al. Arthroscopic treatment of symptomatic discoid meniscus in children: classification, technique, and results. Arthroscopy. 2007;23(2):157-63.

Signs & symptoms Signs Symptoms Joint line tenderness ----- 61% Pain --------- 66% Limping ----- 48% Giving way --- 37% Locking ------ 33% Snapping ----- 17% Joint line tenderness ----- 61% Clunk ------------------- 26% Limited extension ------- 24% Locked knee ------------ 18% McMurray’s test --------- 14% Asik M. et al. Discoid lateral meniscus: diagnosis and results of arthroscopic treatment. Knee Surg Sport Traumatol Arthrosc. 2003;11(2):99-104.

O’Connor’s classification of discoid lateral meniscus ruptures simple horizontal Combined horizontal, longitudinal rupture transverse rupture multiple rupture central rupture Shahriaree H, O’Connor’s textbook of arthroscopic surgery. Lippincott, Philadelpia, 1984, 318-321

Treatment Found incidentally – observe Type I or II not torn/stable Arthroscopic saucerization to rim of 6-8 mm Type I or II torn/unstable Saucerization followed by repair Christopher S. New Modalities for the Pediatric Discoid Meniscus. Columbia University Medical Center Childrens Hospital of New York. 2015.

Technical consideration patient positioning, equipment and technical portals: Leg hang over the operation table tourniquet pressure --------- 250 mm Hg general anesthesia standard 4.5 mm , 30 ̊ arthroscop -------- from 4 years arthro-pressure pump ---------- maximum 40 mm Hg 3.5 mm shaver arthroscopic knife (Beaver knife) Beautifula P and Verdonk R.Thacnical of meniscoplasty and meniscal repair in children. The meniscuse. 2010.

Technical consideration Clinical notes: Highly demanding arthroscopic procedure Lateral portal ------- more proximal and lateral placement Medial portal ------ using an outside to inside needle

4. Inferior and superior aspect probing

5. Peripheral rim inspection 6. Anterior part incision with knife

Technical consideration Clinical notes: 7. Debridement of central horizontal tears 8. Remove the unstable leaf The Meniscus. Editors: Beaufils, Philippe, Verdonk, René 2010; 247-267

9. Leaving a 6-8 mm peripheral substance 10. Final peripheral stability testing ( posterior & anterior ) 11. Suture for instability ---------- outside-in or all-inside Beautifula P and Verdonk R.Thacnical of meniscoplasty and meniscal repair in children. The meniscuse. 2010.

Complete discoid meniscus with anterior instability arthroscopic saucerization (B) outside-in repair technique.

Complete discoid meniscus with posterior instability that was treated with arthroscopic saucerization and inside-out repair technique.

complications Insufficient anterior resection anterior knee pain persistent instability snapping symptoms Osteochondritis dissecans in LFC Instrument breakage

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