Baylor College of Medicine, Houston, Texas, USA; Texas Children's Hospital, Houston, Texas, USA.
Baylor College of Medicine, Houston, Texas, USA.
Am J Sports Med. 2023 Nov;51(13):3493-3501. doi: 10.1177/03635465231206173. Epub 2023 Oct 29.
Surgical treatment options of discoid lateral meniscus in pediatric patients consist of saucerization with or without meniscal repair, meniscocapular stabilization, and, less often, subtotal meniscectomy.
To describe a large, prospectively collected multicenter cohort of discoid menisci undergoing surgical intervention, and further investigate corresponding treatment of discoid menisci.
Cohort study; Level of evidence, 3.
A multicenter quality improvement registry (16 institutions, 26 surgeons), Sports Cohort Outcomes Registry, was queried. Patient characteristics, discoid type, presence and type of intrasubstance meniscal tear, peripheral rim instability, repair technique, and partial meniscectomy/debridement beyond saucerization were reviewed. Discoid meniscus characteristics were compared between age groups (<14 and >14 years old), based on receiver operating characteristic curve, and discoid morphology (complete and incomplete).
In total, 274 patients were identified (mean age, 12.4 years; range, 3-18 years), of whom 55.6% had complete discoid. Meniscal repairs were performed in 55.1% of patients. Overall, 48.5% of patients had rim instability and 36.8% had >1 location of peripheral rim instability. Of the patients, 21.5% underwent meniscal debridement beyond saucerization, with 8.4% undergoing a subtotal meniscectomy. Patients <14 years of age were more likely to have a complete discoid meniscus ( < .001), peripheral rim instability ( = .005), and longitudinal tears ( = .015) and require a meniscal repair ( < .001). Patients ≥14 years of age were more likely to have a radial/oblique tear ( = .015) and require additional debridement beyond the physiologic rim ( = .003). Overall, 70% of patients <14 years of age were found to have a complete discoid meniscus necessitating saucerization, and >50% in this young age group required peripheral stabilization/repair.
To preserve physiological "normal" meniscus, a repair may be indicated in >50% of patients <14 years of age but occurred in <50% of those >14 years. Additional resection beyond the physiological rim may be needed in 15% of younger patients and 30% of those aged >14 years.
儿童患者盘状外侧半月板的手术治疗选择包括半月板切开术加或不加半月板修复、半月板肩胛稳定术，以及较少见的半月板次全切除术。
描述一个大型的、前瞻性的多中心盘状半月板手术干预队列，并进一步研究盘状半月板的相应治疗方法。
队列研究；证据水平，3 级。
对多中心质量改进登记处（16 个机构，26 名外科医生）、Sports Cohort Outcomes Registry 进行了查询。对患者特征、盘状类型、半月板内实质撕裂的存在和类型、外周边缘不稳定、修复技术以及除半月板切开术以外的半月板部分切除术/清创术进行了回顾。根据受试者工作特征曲线和盘状形态（完全和不完全），对<14 岁和>14 岁年龄组的盘状半月板特征进行了比较。
共确定了 274 例患者（平均年龄 12.4 岁；范围 3-18 岁），其中 55.6%为完全盘状。55.1%的患者进行了半月板修复。总体而言，48.5%的患者存在边缘不稳定，36.8%的患者存在多个外周边缘不稳定部位。21.5%的患者除了半月板切开术以外还进行了半月板清创术，8.4%的患者进行了半月板次全切除术。<14 岁的患者更有可能存在完全盘状半月板（<0.001）、外周边缘不稳定（=0.005）和纵向撕裂（=0.015），并需要半月板修复（<0.001）。≥14 岁的患者更有可能存在放射状/斜向撕裂（=0.015）和需要在生理边缘以外进行额外的清创术（=0.003）。总体而言，70%的<14 岁患者存在完全盘状半月板，需要进行半月板切开术，而在这个年轻的年龄组中，>50%的患者需要进行外周稳定/修复。
为了保留生理性“正常”半月板，>50%的<14 岁患者可能需要进行修复，但在>14 岁的患者中，这种修复的发生率<50%。在较年轻的患者中，15%的患者需要在生理边缘以外进行额外的切除，而在>14 岁的患者中，这一比例为 30%。
