Discoid lateral meniscus instability in children: part II.: Repair first to minimise the saucerisation.

Autor: Bauwens PH; Department of Pediatric Orthopaedic Surgery, Lyon University Hospital for Mother and Children, 59 Boulevard Pinel, 69677, Bron, France., Vandergugten S; Pediatric Orthopaedic Surgery Unit, Cliniques Universitaires UCL Saint-Luc Bruxelles, and in Grand Hopital de Charleroi, Lyon, France., Fiquet C; Clinique de l'infirmerie Protestante of Lyon, 1-3 Chemin du Penthod, 69300, Caluire et Cuire, France., Raux S; Department of Pediatric Orthopaedic Surgery, Lyon University Hospital for Mother and Children, 59 Boulevard Pinel, 69677, Bron, France., Cance N; Department of Pediatric Orthopaedic Surgery, Lyon University Hospital for Mother and Children, 59 Boulevard Pinel, 69677, Bron, France., Chotel F; Department of Pediatric Orthopaedic Surgery, Lyon University Hospital for Mother and Children and Claude Bernard University Lyon I., Hospices Civils de Lyon, 59 Boulevard Pinel, 69677, Bron, France. franck.chotel@yahoo.co.uk.
Jazyk: angličtina
Zdroj: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA [Knee Surg Sports Traumatol Arthrosc] 2023 Nov; Vol. 31 (11), pp. 4816-4823. Date of Electronic Publication: 2023 Sep 02.
DOI: 10.1007/s00167-023-07538-1
Abstrakt: Purpose: Despite an improved understanding of discoid lateral meniscus (DLM), the treatment of symptomatic discoid lateral meniscus remains controversial.
Methods: The aim of this retrospective, single-centred, consecutive-case study was to evaluate the clinical outcome of 60 DLM treated arthroscopically by the "meniscoplasty or saucerisation-suture" technique in children and adolescents [median (range) age 11 (4-17) years], and to investigate surgical failures. The instability was assessed before any saucerisation. The hypotheses were that: (i) the management of instability with suture first was effective and that (ii) a combined classification with clinical and MRI data had a prognostic value.
Results: In 57 knees (95%), the DLM was unstable, and a suture fixation was performed. After a median follow-up of 41.5 months, the median (range) IKDC score was improved from 55 (10-70) preoperatively to 90 (37.5-100) postoperatively. The median (range) Lysholm score at last follow-up was 93.5 (45-100). The procedure was effective in 49 knees (81.6%) after a single procedure. Eleven patients had a failure with a new meniscal tear after a median (range) delay of 42 months (24-60) after the initial procedure. The patterns of discoid lateral meniscus instability were not found to have a prognostic value for surgical failure since they mainly occurred after sport-related injuries. All the patients with initial repair failures but one achieved a good clinical outcome after revision repair without any further meniscectomy.
Conclusion: In contrast to adult knees, symptomatic discoid lateral meniscus is rarely stable in children (5%). Meniscal repair is effective to preserve the meniscus tissue, but revision repair became necessary in 18% of the cases and was finally successful. Level of evidence Level III.
(© 2023. The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).)
Databáze: MEDLINE
Externí odkaz: