Meniscus Preservation Strategies: Restoration to Transplantation (2023 Annual Meeting)-Managing the Discoid Meniscus

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The discoid meniscus is a congenital variant, most often affecting the lateral meniscus, characterized by a disc-shaped structure with disorganized collagen fibers. Classification systems include Watanabe's and the more recent PRISM, which assesses meniscal shape, height, tears, and stability to guide treatment. Peripheral rim instability is common, occurring in 25-75% of cases, and can be anterior, posterior, or mid-body. Patients, mainly children, present with lateral knee pain, locking, swelling, or limited extension. Diagnosis involves X-rays and MRI, notably the "bow tie" sign indicating discoid meniscus. Surgery is typically indicated for symptomatic cases, shifting from total meniscectomy to arthroscopic saucerization, repair, and stabilization to preserve meniscal tissue and prevent arthritis. Surgical pearls include addressing concurrent pathologies, careful saucerization to preserve rim tissue, staged treatment of shape, tears, and instability, and optimizing healing biology and biomechanics, for example, guided growth for valgus deformity. Monitoring for associated osteochondritis dissecans is crucial. Overall, a tailored, systematic approach yields good outcomes in pediatric patients.

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Cordelia W. Carter, M.D.

Keywords

discoid meniscus

lateral meniscus

PRISM classification

arthroscopic saucerization

pediatric knee surgery