Orthopaedics, Sahyadri Super Speciality Hospital Deccan Gymkhana, Pune, Maharashtra, India
Orthopaedics, Sahyadri Super Speciality Hospital Deccan Gymkhana, Pune, Maharashtra, India.
J ISAKOS. 2021 Jan;6(1):14-21. doi: 10.1136/jisakos-2017-000162. Epub 2020 Sep 16.
The discoid meniscus is a congenital morphological abnormality encountered far more commonly on the lateral than the medial side. The discoid lateral meniscus (DLM) is more prevalent in Asia with an incidence of 10%-13%, than in the Western world with an incidence of 3%-5%. DLM can be bilateral in more than 80% cases. Due to its abnormal shape and size, the discoid meniscus is prone to tearing and has an impact on gait mechanics. The discoid meniscus has deranged collagen arrangement and vascularity which can have implications for healing after a repair. Patients with a DLM may or may not be symptomatic with mechanical complaints of locking, clicking, snapping or pain. Symptoms often arise due to a tear in the body of the meniscus or a peripheral detachment. Asymptomatic patients usually do not require any treatment, while symptomatic patients who do not have locking are managed conservatively. When a peripheral detachment is present, it must be stabilised while preserving the meniscus rim to allow transmission of hoop stresses. Rehabilitation after surgery is highly individualised and return to sports is possible after more than 4 months in those undergoing a repair. The functional outcomes and onset of radiographic arthritis after saucerisation and repairing a discoid meniscus are better in the long term, compared with a subtotal meniscectomy. However, there is no compelling evidence currently favouring a repair as results deteriorate with increasing follow-up. Poor prognosis is reported in patients undergoing a total meniscectomy, a higher age at presentation and valgus malalignment.
盘状半月板是一种先天性的形态异常，外侧比内侧更为常见。外侧盘状半月板（DLM）在亚洲的发病率为 10%-13%，高于西方的 3%-5%。80%以上的病例为双侧。由于其异常的形状和大小，盘状半月板容易撕裂，并影响步态力学。盘状半月板的胶原排列和血管紊乱，这可能对修复后的愈合有影响。DLM 患者可能有或没有症状，表现为机械性的交锁、弹响、卡压或疼痛。症状通常是由于半月板体部撕裂或边缘分离引起的。无症状患者通常不需要任何治疗，而无症状但没有交锁的患者则采用保守治疗。当存在边缘分离时，必须稳定半月板边缘，以允许环向应力的传递。手术后的康复是高度个体化的，对于接受修复的患者，4 个月后可以重返运动。与半月板次全切除术相比，盘状半月板切除和修复后的功能结果和放射学关节炎的发生在长期内更好。然而，目前没有确凿的证据支持修复，因为随着随访时间的延长，结果会恶化。在接受半月板全切术的患者中，预后较差，发病年龄较大和外翻畸形。
