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

2. 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.

3. 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):

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

5. 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,

6. 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

7. Technical consideration
patient positioning, equipment and technical portals:
Leg hang over the operation table
tourniquet pressure 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

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

9. 4. Inferior and superior aspect probing

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

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

12. 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

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

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

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

16. Thank you