University of Washington School of Medicine, Seattle, Washington, USA.
OrthoSport Victoria, Melbourne, Victoria, Australia.
Am J Sports Med. 2024 Sep;52(11):2758-2763. doi: 10.1177/03635465241272393. Epub 2024 Sep 2.
Discoid lateral meniscus (DLM) is the most common congenital abnormality of the meniscus. Tears are common; treatment is frequently not definitive, often requiring reoperation.
To report the clinical manifestations, physical characteristics, operative treatments and findings, complications, and reoperations of DLM in pediatric patients from multiple centers across North America.
Case series; Level of evidence, 4.
Consecutive patients who underwent treatment for symptomatic DLM at 9 institutions between 2000 and 2020 were included. Patient data, presenting symptoms and signs, surgical findings, treatments rendered, and postoperative complications, including reoperation rates, were collected. Means with ranges and counts with proportions are reported for continuous and categorical variables, respectively, and comparisons were made using either the chi-square or Fisher exact test.
In total, 784 patients (867 knees) were included with a mean age at diagnosis of 12 years (range, 1-22 years) and a mean follow-up of 22.6 months (range, 0-154 months). Common preoperative symptoms were locking (33%) and snapping (30%). At surgery, tears in the DLM were present in 647 knees (594 patients [76%]); 95 knees (11%) had multiple tears; and in 140 knees, tears extended into >1 zone. Tears, when present, were more common within the posterior horn (41%) or body (34%) than the anterior horn (25%). Peripheral rim instability was reported in 241 knees (28%). Significantly more knees had instability posteriorly (15%; = .0004) and anteriorly (9%; = .0013) than along the body (3%). Tear type was most commonly complex (38%) or horizontal (34%). A total of 358 knees in 333 patients with tears (42% of all patients) underwent repair (55% of knees with tears). A total of 175 complications were reported, occurring in 139 knees in 134 patients (17%); 116 of these knees with complications (83%) had a single complication, while 23 (17%) had >1. Of the 784 patients, 105 (13%) underwent reoperation, undergoing 135 additional procedures related to their DLM. Of those, 60 (44%) were repeat arthroscopy and meniscal trim; 40 (30%), arthroscopy and meniscal repair; and 17 (13%), an articular cartilage procedure.
Locking and snapping were common presenting symptoms. Over three-quarters of patients had meniscal tears, which were most often complex and located posteriorly. Seventeen percent of patients experienced complications, and a sixth of patients with complications had >1. Reoperation was typically for persistent symptoms or meniscal retear.
盘状外侧半月板（DLM）是半月板最常见的先天性异常。半月板撕裂很常见；治疗通常不是确定性的，经常需要再次手术。
报告北美多家中心的儿科患者中 DLM 的临床表现、体格特征、手术治疗和发现、并发症以及再次手术情况。
病例系列；证据水平，4 级。
连续纳入 2000 年至 2020 年期间在 9 家机构接受治疗的有症状 DLM 的患者。收集患者数据、主要症状和体征、手术发现、治疗方法以及术后并发症（包括再手术率）。连续变量采用均值和范围表示，分类变量采用计数和比例表示，采用卡方检验或 Fisher 确切概率法进行比较。
共纳入 784 例患者（867 膝），诊断时的平均年龄为 12 岁（范围，1-22 岁），平均随访时间为 22.6 个月（范围，0-154 个月）。术前常见的症状为交锁（33%）和弹响（30%）。术中，647 膝（594 例患者[76%]）存在 DLM 撕裂；95 膝（11%）存在多发撕裂；140 膝撕裂延伸超过 1 个区。撕裂部位多见于半月板后角（41%）或体部（34%），前角（25%）少见。241 膝（28%）存在半月板外周缘不稳定。后角（15%； =.0004）和前角（9%； =.0013）不稳定的膝明显多于体部（3%）。撕裂类型最常见的是复杂型（38%）或水平型（34%）。共有 358 膝（333 例患者，占所有患者的 42%）接受了修复（有撕裂的膝关节的 42%）。共报告了 175 例并发症，发生于 134 例患者的 139 膝（17%）；135 例存在并发症的膝关节（83%）有 1 种并发症，23 膝（17%）有 >1 种。784 例患者中，105 例（13%）接受了再次手术，共进行了 135 次与 DLM 相关的附加手术。其中，60 例（44%）为再次关节镜检查和半月板修整；40 例（30%）为关节镜检查和半月板修复；17 例（13%）为关节软骨手术。
交锁和弹响是常见的主要症状。超过 3/4 的患者存在半月板撕裂，撕裂最常见于后角且多为复杂型。17%的患者出现并发症，1/6 存在并发症的患者有 >1 种并发症。再次手术通常是为了治疗持续存在的症状或半月板再撕裂。
